[Pages S895-S924]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Mr. WYDEN (for himself and Mr. Smith of Oregon):
S. 294. A bill to direct the Secretary of the Army to develop and
implement a comprehensive program for fish screens and passage devices;
to the Committee on Environment and Public Works.

water diversion protection and fisheries enhancement program

<bullet> Mr. WYDEN. Mr. President, the legislation I introduce today
will help the people of the Pacific Northwest address one of the most
important natural resource issues in the region: the restoration of our
majestic salmon runs. This bill will lend a much-needed hand to
Oregonians and other Northwesterners who have been working together to
find common sense solutions to preserve this precious natural resource.
As many people know, any effort to recover these salmon runs must be
both creative and comprehensive, due to the complex nature of the
salmon life cycle. Salmon are hatched in fresh water, migrate down
streams and rivers to the sea to grow and mature, and then return to
the streams of their birth to spawn. This complex life cycle exposes
the fish to many hazards which threaten their survival. If we are to
achieve our goal of restoring salmon runs to healthy levels, we must
identify and address the various causes of salmon mortality.
One of the hazards facing salmon and other fish is the diversion of
water from streams and rivers to irrigate agricultural crops. Migrating
juvenile fish, including endangered salmon and bull trout, are killed
when they are diverted from rivers and streams along with water used
for irrigation.
The common-sense solution to this pervasive problem is to safely
screen the points of water diversion: to allow water through while
keeping fish out. Despite existing State and Federal programs to assist
with the installation of fish screens, unscreened diversions continue
to be a significant problem for endangered fish in the Pacific
Northwest.
My home state of Oregon has identified fish mortality caused by water
diversions as a priority problem. One of Oregon's primary goals
relating to salmon restoration is to encourage the installation of fish
screens and passage devices for water diversions on streams and rivers.
Oregon has developed a cooperative program to assist in screening
smaller diversions used on family farms. However, the State cannot
afford to provide similar assistance for larger sized diversions.
That's where the Federal government can help.
This bill gives the U.S. Army Corps of Engineers new authority to
help irrigators make their water systems safer for fish. Participation
by irrigators in the program will be voluntary and will require a
sharing of the cost.
I believe this legislation will be very effective because irrigators
from Oregon and the other Northwest states have told me they want to
make their water systems more fish-friendly, but

[[Page S896]]

they need help to do so. This bill will give them the help they need
and will greatly benefit the current efforts of local irrigation
districts and watershed councils to conserve and protect our fish runs.
I am pleased that this legislation is cosponsored by Senator Gordon
Smith and has support from all the Northwest irrigation groups and
literally dozens of Northwest and national conservation and sport
fishing groups, including National Audubon Society, Natural Resources
Defense Council, Oregon Trout, Trout Unlimited, American Rivers,
Pacific Coast Federation of Fishermen's Associations, and Northwest
Sportfishing Industries Association.
Despite our best efforts to restore these salmon runs, they continue
to decline year after year. We need a fresh approach to this problem--
one that involves the participation of the local folks who are affected
by conservation efforts. This bill takes that approach.
Of course, a fish screen program alone is not the missing clue to
solve our salmon problem. But this program, along with others like the
Clean Water bill I introduced last session with Senator Burns are
pieces of the complete puzzle.
Ultimately, it will take the integrated efforts of all interests in
our region to recover our salmon successfully. State, Tribal and local
governments, local watershed councils, private landowners and the
Federal government will all need to work together. Initiatives like
this fish screen bill will help forge the partnerships upon which
successful salmon recovery will be based. I urge your support for this
legislation, so that the people of the Pacific Northwest can continue
their important work to restore this precious natural resource.<bullet>
______

By Mr. LUGAR:
S. 295. A bill to amend part S of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 to permit the use of certain
amounts for assistance to jail-based substance treatment programs, and
for other purposes; to the Committee on the Judiciary.

jail-based substance abuse treatment program

<bullet> Mr. LUGAR. Mr. President, I rise today to offer legislation
amending the Residential Substance Abuse Treatment program, known as R-
SAT, to enable jurisdictions below the state level to realize greater
benefits from the program. The R-SAT program allows the Attorney
General to make grants for the establishment of treatment programs
within local correctional facilities, but only a few jurisdictions have
been able to take advantage of these grants.
The legislation I am offering today will solve this problem by
establishing a separate Jail-Based Substance Abuse Treatment Program,
or J-SAT. Under this new program, states will be explicitly authorized
to devote up to ten percent of the funds they receive under R-SAT to
qualifying J-SAT programs.
This legislation will provide matching funds to jail-based treatment
programs that meet several criteria. First, the program must be at
least three months in length. This is the minimum amount of time for a
treatment program to have the desired effect. To qualify for funding, a
program must also have been in existence for at least two years. This
criterion is intended to ensure that jurisdictions which have already
demonstrated a commitment to treatment programs at the local level
receive first priority for funding. It also ensures that scarce
treatment resources are allocated to programs with a demonstrable track
record of success. The third criterion for programs seeking J-SAT
funding is that the treatment regimen must include regular drug
testing. This is necessary to ensure that some objective measure of the
program's success is available. Grant recipients are also encouraged to
provide the widest range of aftercare services possible, including job
training, education and self-help programs. These steps are necessary
to leverage the resources devoted to solving the problem of substance
abuse, and to give individuals involved in treatment the best possible
chance for successful rehabilitation.
I am offering this legislation because substance abuse and problems
arising from it are putting a severe strain on the resources of local
jurisdictions throughout the nation. This is not a minor problem. The
Office of National Drug Control Policy indicates that approximately
three-fourths of prison inmates--and over half of those in jails or on
probation--are substance abusers, yet only a small percentage of
inmates participate in treatment programs while they are incarcerated.
The time during which drug-using offenders are in custody or under
post-release correctional supervision presents a unique opportunity to
reduce drug use and crime through effective drug testing and treatment
programs.
Research indicates that programs like J-SAT can help to reduce the
strain on our communities by cutting drug use in half; by reducing
other criminal activity like shoplifting, assault, and drug sales by up
to 80 percent; and by reducing arrests for all crimes by up to 64
percent.
I would also note that jail-based treatment programs are cost
effective. In 1994, the American Correctional Association estimated the
annual cost of incarceration at $18,330. The Office of National Drug
Control Policy states that treatment while in prison and under post-
incarceration supervision can reduce recidivism by roughly 50 percent.
Thus, for every $1,800 the government invests in treatment, it saves
more than $9,000. Former Assistant Health Secretary Philip Lee has
estimated that every dollar invested in treatment can save $7 in
societal and medical costs.
For these reasons, I ask my colleagues to support the Jail-Based
Substance Abuse Treatment legislation I am introducing today. I also
ask unanimous consent that the bill be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 295

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. JAIL-BASED SUBSTANCE ABUSE TREATMENT PROGRAMS.

(a) In General.--Part S of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 (42 U.S.C. 3796ff et
seq.) is amended by adding at the end the following:

``SEC. 1906. JAIL-BASED SUBSTANCE ABUSE TREATMENT.

``(a) Definitions.--In this section--
``(1) the term `jail-based substance abuse treatment
program' means a course of individual and group activities,
lasting for a period of not less than 3 months, in an area of
a correctional facility set apart from the general population
of the correctional facility, if those activities are--
``(A) directed at the substance abuse problems of
prisoners; and
``(B) intended to develop the cognitive, behavioral,
social, vocational, and other skills of prisoners in order to
address the substance abuse and related problems of
prisoners; and
``(2) the term `local correctional facility' means any
correctional facility operated by a unit of local government.
``(b) Authorization.--
``(1) In general.--Not less than 10 percent of the total
amount made available to a State under section 1904(a) for
any fiscal year may be used by the State to make grants to
local correctional facilities in the State for the purpose of
assisting jail-based substance abuse treatment programs
established by those local correctional facilities.
``(2) Federal share.--The Federal share of a grant made by
a State under this section to a local correctional facility
may not exceed 75 percent of the total cost of the jail-based
substance abuse treatment program described in the
application submitted under subsection (c) for the fiscal
year for which the program receives assistance under this
section.
``(c) Applications.--
``(1) In general.--To be eligible to receive a grant from a
State under this section for a jail-based substance abuse
treatment program, the chief executive of a local
correctional facility shall submit to the State, in such form
and containing such information as the State may reasonably
require, an application that meets the requirements of
paragraph (2).
``(2) Application requirements.--Each application submitted
under paragraph (1) shall include--
``(A) with respect to the jail-based substance abuse
treatment program for which assistance is sought, a
description of the program and a written certification that--
``(i) the program has been in effect for not less than 2
consecutive years before the date on which the application is
submitted; and
``(ii) the local correctional facility will--

``(I) coordinate the design and implementation of the
program between local correctional facility representatives
and the appropriate State and local alcohol and substance
abuse agencies;
``(II) implement (or continue to require) urinalysis or
other proven reliable forms of substance abuse testing of
individuals participating in the program, including the
testing of individuals released from the jail-based substance
abuse treatment program

[[Page S897]]

who remain in the custody of the local correctional facility;
and
``(III) carry out the program in accordance with
guidelines, which shall be established by the State, in order
to guarantee each participant in the program access to
consistent, continual care if transferred to a different
local correctional facility within the State;

``(B) written assurances that Federal funds received by the
local correctional facility from the State under this section
will be used to supplement, and not to supplant, non-Federal
funds that would otherwise be available for jail-based
substance abuse treatment programs assisted with amounts made
available to the local correctional facility under this
section; and
``(C) a description of the manner in which amounts received
by the local correctional facility from the State under this
section will be coordinated with Federal assistance for
substance abuse treatment and aftercare services provided to
the local correctional facility by the Substance Abuse and
Mental Health Services Administration of the Department of
Health and Human Services.
``(d) Review of Applications.--
``(1) In general.--Upon receipt of an application under
subsection (c), the State shall--
``(A) review the application to ensure that the
application, and the jail-based residential substance abuse
treatment program for which a grant under this section is
sought, meet the requirements of this section; and
``(B) if so, make an affirmative finding in writing that
the jail-based substance abuse treatment program for which
assistance is sought meets the requirements of this section.
``(2) Approval.--Based on the review conducted under
paragraph (1), not later than 90 days after the date on which
an application is submitted under subsection (c), the State
shall--
``(A) approve the application, disapprove the application,
or request a continued evaluation of the application for an
additional period of 90 days; and
``(B) notify the applicant of the action taken under
subparagraph (A) and, with respect to any denial of an
application under subparagraph (A), afford the applicant an
opportunity for reconsideration.
``(3) Eligibility for preference with aftercare
component.--
``(A) In general.--In making grants under this section, a
State shall give preference to applications from local
correctional facilities that ensure that each participant in
the jail-based substance abuse treatment program for which a
grant under this section is sought, is required to
participate in an aftercare services program that meets the
requirements of subparagraph (B), for a period of not less
than 1 year following the earlier of--
``(i) the date on which the participant completes the jail-
based substance abuse treatment program; or
``(ii) the date on which the participant is released from
the correctional facility at the end of the participant's
sentence or is released on parole.
``(B) Aftercare services program requirements.--For
purposes of subparagraph (A), an aftercare services program
meets the requirements of this paragraph if the program--
``(i) in selecting individuals for participation in the
program, gives priority to individuals who have completed a
jail-based substance abuse treatment program;
``(ii) requires each participant in the program to submit
to periodic substance abuse testing; and
``(iii) involves the coordination between the jail-based
substance abuse treatment program and other human service and
rehabilitation programs that may assist in the rehabilitation
of program participants, such as--

``(I) educational and job training programs;
``(II) parole supervision programs;
``(III) half-way house programs; and
``(IV) participation in self-help and peer group programs;
and

``(iv) assists in placing jail-based substance abuse
treatment program participants with appropriate community
substance abuse treatment facilities upon release from the
correctional facility at the end of a sentence or on parole.
``(e) Coordination and Consultation.--
``(1) Coordination.--Each State that makes 1 or more grants
under this section in any fiscal year shall, to the maximum
extent practicable, implement a statewide communications
network with the capacity to track the participants in jail-
based substance abuse treatment programs established by local
correctional facilities in the State as those participants
move between local correctional facilities within the State.
``(2) Consultation.--Each State described in paragraph (1)
shall consult with the Attorney General and the Secretary of
Health and Human Services to ensure that each jail-based
substance abuse treatment program assisted with a grant made
by the State under this section incorporates applicable
components of comprehensive approaches, including relapse
prevention and aftercare services.
``(f) Use of Grant Amounts.--
``(1) In general.--Each local correctional facility that
receives a grant under this section shall use the grant
amount solely for the purpose of carrying out the jail-based
substance abuse treatment program described in the
application submitted under subsection (c).
``(2) Administration.--Each local correctional facility
that receives a grant under this section shall carry out all
activities relating to the administration of the grant
amount, including reviewing the manner in which the amount is
expended, processing, monitoring the progress of the program
assisted, financial reporting, technical assistance, grant
adjustments, accounting, auditing, and fund disbursement.
``(3) Restriction.--A local correctional facility may not
use any amount of a grant under this section for land
acquisition or a construction project.
``(g) Reporting Requirement; Performance Review.--
``(1) Reporting requirement.--Not later than March 1 of
each year, each local correctional facility that receives a
grant under this section shall submit to the Attorney
General, through the State, a description and evaluation of
the jail-based substance abuse treatment program carried out
by the local correctional facility with the grant amount, in
such form and containing such information as the Attorney
General may reasonably require.
``(2) Performance review.--The Attorney General shall
conduct an annual review of each jail-based substance abuse
treatment program assisted under this section, in order to
verify the compliance of local correctional facilities with
the requirements of this section.
``(h) No Effect on State Allocation.--Nothing in this
section shall be construed to affect the allocation of
amounts to States under section 1904(a).''.
(b) Technical Amendment.--The table of contents for title I
of the Omnibus Crime Control and Safe Streets Act of 1968 (42
U.S.C. 3711 et seq.) is amended, in the matter relating to
part S, by adding at the end the following:

``1906. Jail-based substance abuse treatment.''.<bullet>
______

By Mr. FRIST (for himself, Mr. Rockefeller, Mr. Domenici, Mr.
Lieberman, Mr. Gramm, Mr. Bingaman, Mr. Burns, Mr. Breaux, Mrs.
Hutchison, Mr. Cleland, Mr. Thompson, Mr. Kerry, Mr. DeWine,
Mr. Kerrey, Mr. Abraham, Mr. Akaka, Mr. Allard, Mrs. Boxer, Mr.
Roberts, and Mr. Robb):
S. 296. A bill to provide for continuation of the Federal research
investment in a fiscally sustainable way, and for other purposes; to
the Committee on Commerce, Science, and Transportation.

federal research investment act of 1999

<bullet> Mr. FRIST. Mr. President, I rise today to introduce
legislation that would elevate Congress' commitment to technological
innovation and long-term economic growth. The Federal Research
Investment Act specifically targets federally-funded, civilian research
and development (R&D), while establishing greater accountability
mechanisms for both Congress and the White House. The bill would
bolster the aggregate amount of federal funding for R&D over an 11-year
period. Although this legislation passed the Senate by unanimous
consent last year, the rush to finish the 1999 federal budget kept it
from reaching the floor of the House of Representatives and the
President's desk.
Senator Rockefeller, my partner in this endeavor, and I are not
discouraged. We believe that we laid a solid foundation to build on by
getting this legislation through the Senate last year. Now, we intend
to persistently advocate for increased funding levels for basic R&D
until they are realized. This legislation is the product of numerous
hearings, caucus events, forums, and meetings with scientists and
scholars from across the country. We have been working closely together
on this legislation and feel that now, more than ever, Congress must
advocate for greater R&D funding to preserve the future economic
prosperity of our nation.
Innovation is a key element of economic growth in the United States.
Economists widely agree that more than 50 percent of our economic
growth is directly linked to technological innovation. It is the
principle driving force behind our long-term growth and our rising
standard of living. Technology contributes to economic growth through
the creation of new jobs, new goods and services, new capital and even
new industries.
The Federal Government plays a critical role in driving the
innovation process in the United States. The majority of the Federal
Government's basic R&D is directed toward critical missions to serve
the public interest in areas including health, environmental pollution
control, space exploration,

[[Page S898]]

and national defense. Federal funds support nearly 60 percent of the
nation's basic research, with a similar share performed in colleges and
universities. Congressional support reflects a consensus that although
basic research is the foundation for many innovations, the rate of
return to society generated by investments in R&D is significantly
larger than the benefits that can be captured by the performing
institution.
The National Institutes of Health (NIH) received the largest dollar
increase in history in the fiscal year (FY) 1999 federal budget. The
agency received a record 14.1 percent increase in its R&D budget,
nearly $2 billion. Due to steady increases every year, the NIH R&D
budget is now 28 percent larger in inflationary-adjusted terms than it
was in FY 1994.
NIH's overwhelming support by Congress reflects a growing popular
movement both in the Senate and House to double funding for NIH over
the next five years. Many of my colleagues, eager to fund the
biotechnology that enables our citizens to live longer, more healthy
lives, are embracing this crusade. I believe, however, many of them are
missing the critical link that exists between the breakthrough advances
we are experiencing today and what has enabled them to occur. The
funding surge of R&D in the sciences in the 1960's created a wealth of
research opportunities for scientists throughout the nation. Since that
time though, funding has declined steadily with no hint of a reversal
of that downward trend. If we are to dedicate ourselves to advancement
of biotechnology and all the benefits that it will afford, we must
support it with solid funding for the basic sciences. One truly depends
upon the other. And that critical link, I believe, has been lost in the
revolution of health care policy.
Fiscal constraints due to recent efforts to balance the federal
budget threaten the U.S. R&D infrastructure. This is due to both a
long-term problem of the ever-increasing level of mandatory spending of
discretionary funding that must be allocated across an increasing range
of programs. Now, for the first time in nearly three decades, the
Federal Government has attained a budget surplus of $70 billion in
1998. Additionally, the Congressional Budget Office estimates a budget
surplus of approximately $1.5 trillion over the next ten years. As
Congress debates how to allocate surplus funds, serious consideration
must be given to federal research and development investment.
As a result of the current monetary environment in Congress and the
desire to utilize the surplus prudently, I am confident that investing
in basic R&D, and in turn the technological innovation of the future,
is a proper use of the federal taxpayers dollars. Furthermore, the
increased funding called for in this legislation is coupled with a
judicious strategy for federal investment and strong accountability
mechanisms to help guide the Administration and Congress. Nothing less
is acceptable.
Mr. President, despite its modest share of total U.S. R&D funding,
the Federal Government continues to play a vital role in the nation's
R&D enterprise. With dramatic decreases in U.S. defense R&D spending in
the post Cold-War era, devoting attention to civilian basic research is
more critical now than ever before. This pivotal need for a resurgence
in basic R&D investments is evident when we further consider our
nation's increased dependency on technology and the global competition
that threatens our sustained leadership position. R&D drives the
innovation process, which in turn drives the U.S. economy. Now is not
the time to turn our backs on the nation's future prosperity.<bullet>
<bullet> Mr. ROCKEFELLER. Mr. President, I would like to join Senator
Frist and other distinguished colleagues in introducing the Federal
Research Investment Act. This legislation will set a long-term vision
for federal funding of research and development programs so that the
United States can continue to be the world leader in high-tech
industries.
One only needs to look as far as the front page of the newspaper to
see the effect of high-technology on our country. New drugs are
becoming available for fighting cancer; new communication hardware is
allowing more people to connect to the internet; and advances in fuel-
cell technology are leading to low-emission, high-efficiency
alternative fuel vehicles. In fact, seventy percent of all patent
applications cite non-profit or federally-funded research as a core
component to the innovation being patented. People are living longer,
with a higher quality of life, in a better economy due to processes,
procedures, and equipment which are based on federally-funded research.
What I am afraid of is that many people are not aware that these
products do not simply appear out of nowhere. They are the result of a
basis of knowledge which has been built up by researchers supported by
federal funding. American companies pull from this knowledge base in
order to develop the latest high-tech products which you and I read
about in the paper and see on our store shelves every day.
I view this knowledge base as a bank. The U.S. government puts in
modest amounts of funding in the form of support for scientific
research. The payback comes from the economic growth which is produced
as this knowledge is turned into actual products by American companies.
In fact, a large part of the current rosy economic situation is due
to our dominant high-tech industries. High-tech companies are currently
responsible for one-third of our economic output and half of our
economic growth. However, if we are to continue at this pace, we need
to support the fundamental, pre-competitive research critical to these
industries, at the necessary levels, and in a stable manner from year
to year, and we need to do so now.
In the last session of the 105th Congress Senators Frist, Bingaman,
Domenici, Gramm, Breaux, Burns, and I introduced S. 2217, the Federal
Research Investment Act, and previous to that Senators Domenici and
Bingaman, introduced S. 1305, the National Research Investment Act.
Both S. 1305 and S. 2217 have been extremely successful in galvanizing
members of the scientific and engineering community to pull together
and work constructively towards a common ideal. In addition, it has
brought together the co-sponsors of these bills and moved them forward
as a group with their original idea. S. 2217 passed without dissent in
the Senate at the end of last session, and gained 36 co-sponsors--18
Democrats and 18 Republicans. Our aim, in re-introducing the Federal
Research Investment Act, is to now take the next step in this process,
bringing to fruition the goals of our bill.
The Federal Research Investment Act is a long-term vision for federal
R&D funding. It creates legislative language which stresses the
importance of R&D funding to the strength of our nation's innovation
infrastructure. It also sets out guidelines for Congress to use in
prioritizing funding decisions.
Just three years ago, federal science funding was in a serious
decline and fewer than half a dozen members of Congress gave it any
attention, but now as a significant consequence of both S. 1305 and S.
2217 the trend, at least in the last two years, seems to have reversed
and a universal spirit of cooperation for strong R&D funding is
developing on all fronts. In the last two years the science budget has
increased above inflation. In particular, for Fiscal Year 1999, an
unprecedented 10% increase in civilian R&D funding was appropriated.
Yet, we appear to be in a crisis situation once again due to unexpected
budgetary constraints resulting from last year's appropriations. Thus,
we need to continue our fight to implement the R&D budgetary guidelines
in our bill. This uncertainty in the level of R&D funding from year to
year can be as detrimental to the health of the scientific enterprise
as a lack of adequate funding levels. It will be a sad day for our
nation, and its future economic prosperity, if we manage to lose what
progress we have made to date.
Based on a careful review and analysis of our past history, our bill
authorizes an annual funding increase of 5.5%, starting in the year
2000 and going through 2010, for federally-funded, civilian, R&D
programs. This would increase federal R&D spending to 2.6% of total,
overall budget by 2010, a near doubling in R&D funding from 1998
levels. In order to make sure that these increases are fully
incorporated into budgetary process we request that the President
include these increases in his annual budget request to Congress.
We are currently in an economic upturn. This continues to be a
perfect

[[Page S899]]

time to increase funding for R&D so that we can continue this growth. I
have faith that, as long as the economic situation allows it, my
thoughtful and wise colleagues will support increasing R&D funding to
the levels that we have laid out in this bill. However, I am also a
realist. I realize that the economy may not always remain as strong as
it is right now. That is why we have introduced a funding firewall.
Without this firewall I am seriously concerned that history will repeat
itself. In the past, R&D funding is one of the first things that has
been cut during times of crisis. This is the wrong approach. I believe
that cutting R&D funding levels below a bare minimum level causes
serious, long-term harm to the R&D infrastructure in the United States.
Our firewall would not allow this to happen. It is not meant as a goal,
it is meant as a bare minimum which should only be implemented in the
leanest of years.
Many, if not most, recent `quantum leaps' in knowledge have occurred
at the interface between traditional disciplines of research.
Therefore, we legislatively mandate that this funding increase must be
macroscopically balanced, so that there is not preferential growth of
one agency, program or field of study at the expense of other, equally
qualified and deserving agencies. One of the original reasons that I
started to get involved with technology issues such as EPSCoR and
EPSCoT, was because I believe that technology should be shared by
everyone, not just those in Silicon Valley or the Route 128 corridor in
Boston. Therefore, this bill should not be seen as a means of promoting
elitist science but as a mechanism for allowing for diversity in our
national innovation infrastructure.
Finally, so that we are able to assure other Members of Congress and
the general public that this money authorized by this Act would be well
spent, we have included accountability measures which will assure that
there is no waste of federal money on out-dated, or ill-conceived
projects. This bill puts into place a system of accountability for each
affected agency. Our bill institutes a study by the National Academy of
Sciences to determine how to effectively measure the progress of R&D
based agencies and then have them institute performance measures based
on these metrics. This will allow increases in funding without concerns
over wasteful spending being generated.
In conclusion, with the help of Senators Gramm, Lieberman, Domenici,
and Bingaman, Senator Frist and I have put together a long-term vision
for federal R&D funding which we hope will instigate real increases in
federal funding for research and development. Federally-funded research
has been, and will continue to be, a driving power behind our economic
success. If we are to maintain and enhance our current economic
prosperity we must make sure that research programs are funded at
adequate levels in a consistent long-term manner. I urge my colleagues
to support this bill.<bullet>
<bullet> Mr. DOMENICI. Mr. President, I'm pleased to see the Federal
Research Investment Act introduced in the 106th Congress. This bill is
one that I've supported throughout its history, because it addresses
the health of our nation's science and technology base.
Our science and technology base is vital to the nation's future. Any
number of studies have confirmed its importance. As one excellent
example, the National Innovation Summit, organized by MIT last March
with the Council on Competitiveness, confirmed that the integrity of
that base is one of the cornerstones to our future economic prosperity.
At that Summit, many of the nation's top CEOs emphasized that the
nation's climate for innovation is a major determinant of our ability
to maintain and advance our high standard of living and strong economy.
Advanced technologies are responsible for driving half of our
economic growth since World War II, and that growth has developed our
economy into the envy of the world. We need to continually refresh our
stock of new products and processes that enable good jobs for our
citizens in the face of increasing global challenges to all our
principal industries.
This bill emphasizes a broad range of research targets, from
fundamental and frontier exploration, through pre-competitive
engineering research. This emphasis on a spectrum of research maturity
is absolutely critical. The nation is not well served by a focus on so-
called ``basic'' research that can open new fields, but then leave
those fields without resources to develop new ideas to a pre-
competitive stage applicable to future commercial products and
processes.
The new bill addresses a spectrum of research fields with its
emphasis on expanding S&T funding in many agencies. We need technical
advances in many fields simultaneously. In more and more cases, the
best new ideas are not flowing from explorations in a single narrow
field, but instead are coming from inter-disciplinary studies that
bring experts from diverse fields together for fruitful collaboration.
This is especially evident in medical and health fields, where
combinations of medical science with many other specialities are
critical to the latest health care advances.
This new bill has additional features that were critical components
of last year's S. 2217. It proposes to utilize the National Academy of
Science in developing approaches to evaluation of program and project
performance. This should lead to better understanding of how Government
Performance Results Act goals and scientific programs can be best
coordinated. The new role for the National Academy can help define
criteria to guide decisions on continued and future funding. The bill
also sets up procedures to use these evaluations to terminate federal
programs that are not performing at acceptable levels.
The new bill incorporates a set of well-developed principles for
federal funding of science and technology. These principles were
developed by our Senate Science and Technology Caucus. Those
principles, when carefully applied, can lead to better choices among
the many opportunities for federal S&T funding. The new bill also
incorporates recommendations for independent merit-based review of
federal S&T programs, which should further strengthen them.
Many aspects of the Federal Research Investment Act support and
compliment key points in the study released by Representative Vern
Ehlers last year. His study, ``Unlocking our Future,'' will serve as an
important focal point for continuing discussions on the critical goal
of strengthening our nation's science and technology base.
This Federal Research Investment Act continues the goals expressed in
S. 1305 last year. That was followed by S. 2217 that proposed a more
realistic time scale for achieving this expanded support, added GPRA
performance goals, and included language that recognized the importance
of the budgets caps. This new bill is very similar to S. 2217.
The new Federal Research Investment Act builds and improves on the
goals of the previous bills. With this act, we will build stronger
federal Science and Technology programs that will underpin our nation's
ability to compete effectively in the global marketplace of the 21st
century.<bullet>
______

By Mr. SHELBY:
S. 297. A bill to amend title 37, United States Code, to authorize
members of the uniformed services to participate in the Thrift Savings
Plan, and for other purposes; to the Committee on Governmental Affairs.

THRIFT SAVINGS PLAN (TSP) LEGISLATION

<bullet> Mr. SHELBY. Mr. President, I rise today to introduce
legislation to increase the retirement benefits for military personnel
by allowing them to participate in the Thrift Savings Plan (TSP).
Many of us are concerned about the current state of readiness in our
military forces, and rightly so. In the last decade, the number of
Americans wearing their nation's uniform has decreased precipitously
along with the funding that pays for their weapons, aircraft, ships,
wages, housing, and benefits. Tragically, as the defense budget
withers, our military's operational tempo soars. Overseas deployments
have steadily increased in number, scope, and duration. Our troops are
working harder than ever and yet, we have failed to support them. In
addition to inadequately funding much needed weapons modernization, we
have kept their wages low and slowly eroded their benefits. As we make
it less and less attractive to serve, we

[[Page S900]]

will not be able to recruit high quality people and those that now
serve will continue to leave. Recruiting and retention are the backbone
of our military services. Without either there is no readiness. Our
service men and women are being stretched to the breaking point, and
they are voting with their feet. We must act now.
Senior Pentagon officials have determined that retirement benefits
are a key consideration in the decision to pursue a military career and
therefore are critical to the retention of our best people. Because of
reduced retirement benefits--commonly referred to as ``Redux''--an
increasing number of mid-career personnel are deciding to leave the
military. In recent testimony to the Senate, General Henry Shelton, the
Chairman of the Joint Chiefs of Staff, stated that ``that is why, among
a number of pressing needs, reforming military retirement and military
pay remains the Joint Chiefs' highest priority.''
The bill I am introducing today is simple and straightforward. It
shores up the military retirement system by allowing military personnel
to supplement direct benefits through participation in the Thrift
Saving Plan (TSP). This legislation will provide ALL military personnel
a retirement benefit that is available to federal employees and all of
us in the Senate and our staffs. Furthermore, the inherent flexibility
of TSP will give military personnel and their families greater control
over their retirement benefits. For these reasons, this legislation is
a priority for the leadership in the Senate.
Specifically, my bill will allow members of the armed services to
contribute up to 5 percent of basic pay in a tax-deferred individual
account where the funds are held in trust and invested and can later be
withdrawn at retirement. As an additional incentive for a military
career, personnel will be qualified to contribute up to 10 percent of
their basic pay after 10 years of service. As is the case with the
Federal Employee Retirement System (FERS), the government would provide
up to 5 percent to match the individual's contribution.
So often we marvel over our high-tech weapons systems and we forget
that they are useless without highly skilled and professional Americans
to operate them. If the services continue to hemorrhage qualified
people at current rates, there will be a reckoning the magnitude of
which we are not prepared to endure. We must take action now to slow
the exodus of qualified personnel from the military. I believe that
this bill will be a powerful tool to assist the services in retaining
personnel, and I urge my colleagues to cosponsor this legislation.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 297

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. PARTICIPATION OF MEMBERS OF THE UNIFORMED SERVICES
IN THE THRIFT SAVINGS PLAN.

(b) Authority.--(1) Chapter 3 of title 37, United States
Code, is amended by adding at the end the following:

``Sec. 211. Participation in Thrift Savings Plan

``(a) Participation Authorized.--(1) A member of the
uniformed services may contribute to the Thrift Savings Fund
out of basic pay.
``(2) An election to contribute to the Thrift Savings Fund
under paragraph (1) may be made only during a period provided
under section 8432(b) of title 5 for individuals subject to
chapter 84 of such title.
``(b) Applicability of Thrift Savings Plan Provisions.--
Except as otherwise provided in this section, the provisions
of subchapters III and VII of chapter 84 of title 5 shall
apply with respect to members of the uniformed services
making contributions to the Thrift Savings Fund as if such
members were employees within the meaning of section 8401(11)
of such title.
``(c) Maximum Contribution From Basic Pay.--(1) The amount
contributed by a member of the uniformed services for any pay
period out of basic pay may not exceed the amount equal to
the maximum allowable percent of such member's basic pay for
such pay period.
``(2) For the purposes of paragraph (1), the maximum
allowable percent of basic pay applicable to a member with
respect to a pay period is as follows:
``(A) If the member has less than 5 years of service
computed under section 205 of title 37 on or before the last
day of the pay period, 5 percent.
``(B) If the member has at least 5 years of service
computed under section 205 of title 37 on or before the last
day of the pay period, 10 percent.
``(d) Agency Contributions.--Contributions shall be made
under paragraph (2), but not any other paragraph, of section
8432(c) of title 5 for the benefit of a member of the
uniformed services making contributions to the Thrift Savings
Fund under subsection (a). For the purposes of this
subsection, the reference in paragraph (2) of such section to
contributions under paragraph (1) of such section does not
apply.
``(e) Rules of Construction.--The following rules of
construction apply for the purposes of this section:
``(1) In applying section 8433 of title 5 to a member of
the uniformed services who has an account balance in the
Thrift Savings Fund, any reference in such section to
separation from Government employment shall be construed to
refer to the following actions:
``(A) Release of the member from active-duty service (not
followed by a resumption of active-duty service within 30
days after the effective date of the release).
``(B) Transfer of the member to an inactive status.
``(C) Transfer of the member by the Secretary concerned to
a retired list maintained by the Secretary.
``(2) The reference in section 8433(g)(1) of title 5 to
contributions made under section 8432(a) of such title shall
be treated as being a reference to contributions made to the
Fund by the member, whether made under this section or
section 8351 or 8432(a) of title 5.''.
(2) The table of sections at the beginning of such chapter
is amended by adding at the end the following:

``211. Participation in Thrift Savings Plan.''.

(b) Relationship to Participation Under Other Authority.--
Section 8432b(b)(2)(B) of title 5, United States Code, is
amended by inserting after ``section 8432(a)'' the following
``of this title or section 211 of title 37''.<bullet>
______

By Mr. SHELBY:
S. 298. A bill to amend the Federal Election Campaign Act of 1971 (2
U.S.C. 431 et seq.) to clarify that donations of hard and soft money by
foreign nationals are prohibited; to the Committee on Rules and
Administration.

prohibition of donations by foreign nationals

<bullet> Mr. SHELBY. Mr. President, I rise today to speak in support of
legislation that I am introducing which is intended to prevent foreign
nationals from making financial contributions to federal elections.
Last October, in the trial of Charlie Trie, Judge Paul L. Friedman
ruled that the Federal Election Campaign Act (FECA) does not prohibit
foreigners from making campaign donations to political parties or
Congressional Campaign Committees. The holding of this case is based on
an extremely narrow reading of the language of the FECA. Judge Friedman
ruled that because the FECA specifically prohibits foreign nationals
from making direct contributions to the campaigns of candidates for
federal office but does not specifically prohibit donations, or ``soft
money'' expenditures to the parties, such donations are not prohibited
by the FECA. While we can argue the merits of this decision and
question whether it merely tracks the letter rather than the entire
spirit of the FECA, it is quite clear that this ruling opens up our
system of federal elections to the possibility of foreign influence.
My bill clarifies the law by amending the FECA to prohibit donations
by foreign nationals to ``a national committee of a political party or
a Senatorial or Congressional Campaign Committee of a national
political party for any purpose.'' This new provision along with the
existing prohibition of direct contributions by foreign nationals, will
provide the Federal Election Commission with the ability to prosecute
those who illegally attempt to influence federal elections. Ultimately,
my bill will get us closer to achieving the desired effect originally
contemplated by the FECA--ensuring that federal campaigns are free of
foreign money.
Mr. President, regardless of any member's views concerning the
direction that campaign finance reform should take, I believe that
amending the FECA to prohibit foreign influence in federal campaigns
requires swift action.<bullet>
______

By Mr. McCAIN (for himself, Mr. Inouye, and Mr. Conrad):
S. 299. A bill to elevate the position of Director of the Indian
Health Service within the Department of Health and Human Services to
Assistant Secretary for Indian Health, and for other purposes; to the
Committee on Indian Affairs.

[[Page S901]]

assistant secretary for indian health act of 1999

<bullet> Mr. McCAIN. Mr. President, I rise to introduce legislation
that will establish the Director of the Indian Health Service within
the Department of Health and Human Services as an Assistant Secretary
for Indian Health. My colleagues, Senators Inouye and Conrad, are
joining me in this effort as original co-sponsors. I am pleased to note
that Congressman Nethercutt from Washington introduced companion
legislation on the House side.
Last year, we came very close to successful passage of this same
bill, but the legislative clock expired. It is our hope that we can
move this legislation forward expeditiously this year as this bill
enjoys widespread support from Indian tribes nationwide and the
Administration.
The history of this legislation spans back several years. Every year,
the Congress deliberates on how best to raise the standard of health
care for all Americans. Yet, in nearly every debate, the health care
needs of Indian people are either marginalized or ignored. The need for
this legislation arose out of the continuing frustration expressed by
the tribes that their health concerns were not adequately addressed
under the existing administrative policy and budgetary processes.
As the primary health care delivery system, the Indian Health Service
is the principal advocate for Indian health care needs, both on the
reservation level and for urban populations. More than 1.3 million
Indian people are served every year by the IHS. At its current
capacity, the IHS estimates that it can only meet 62 percent of tribal
health care needs. The IHS will continue to be challenged by a growing
Indian population as well as an increasing disparity between the health
status of Indian people as compared to other Americans. Thousands of
Indian people continue to suffer from the worst imaginable health care
conditions in Indian country--from diabetes to cancer to infant
mortality. In nearly every category, the health status of Native
Americans falls far below the national standard.
The purpose of this bill can be simplified to three primary needs.
Indian people desire a stronger leadership and policy role within the
primary health care agency, the Department of Health and Human
Services. The Assistant Secretary for Indian Health will ensure that
critical policy and budgetary decisions will be made with the full
involvement and consultation of not only the Indian Health Service, but
also the direct involvement of the Tribal governments.
Second, the enactment of this legislation is consistent with the
unique government-to-government relationship between federally
recognized Indian tribes and the federal government. This legislation
is long overdue in bringing focus and national attention to the health
care status of Indian people and fulfilling the federal trust
responsibility toward Indian tribes.
Finally, passage of this legislation is critical as the Congress is
set to deliberate several pieces of Indian health policy.
Reauthorization of the Indian Health Care Improvement Act and
development of legislation to permanently extend tribal self-governance
authority to tribes will be vital components of Indian health care in
the future. Implementation of this bill is intended to support the
long-standing policies of Indian self-determination and tribal self-
governance and assist Indian tribes who are making positive strides in
providing direct health care to their own communities.
At this critical time, the IHS is in dire need of a senior policy
official who is knowledgeable about the programs administered by the
IHS and who can provide the leadership for the health care needs of
American Indians and Alaska Natives. We continue to pursue passage of
this legislation as many believe that the priority of Indian health
issues within the Department should be raised to the highest levels
within our federal government.
I look forward to working with my colleagues on both sides of the
aisle to ensure prompt passage of this legislation. I ask unanimous
consent that the full text and section-by-section analysis of this bill
be included in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 299

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. OFFICE OF ASSISTANT SECRETARY FOR INDIAN HEALTH.

(a) Establishment.--There is established within the
Department of Health and Human Services the Office of the
Assistant Secretary for Indian Health in order to, in a
manner consistent with the government-to-government
relationship between the United States and Indian tribes--
(1) facilitate advocacy for the development of appropriate
Indian health policy; and
(2) promote consultation on matters related to Indian
health.
(b) Assistant Secretary for Indian Health.--In addition to
the functions performed on the date of enactment of this Act
by the Director of the Indian Health Service, the Assistant
Secretary for Indian Health shall perform such functions as
the Secretary of Health and Human Services (referred to in
this section as the ``Secretary'') may designate. The
Assistant Secretary for Indian Health shall--
(1) report directly to the Secretary concerning all policy-
and budget-related matters affecting Indian health;
(2) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
(3) advise each Assistant Secretary of the Department of
Health and Human Services concerning matters of Indian health
with respect to which that Assistant Secretary has authority
and responsibility;
(4) advise the heads of other agencies and programs of the
Department of Health and Human Services concerning matters of
Indian health with respect to which those heads have
authority and responsibility; and
(5) coordinate the activities of the Department of Health
and Human Services concerning matters of Indian health.
(c) References.--Reference in any other Federal law,
Executive order, rule, regulation, or delegation of
authority, or any document of or relating to the Director of
the Indian Health Service shall be deemed to refer to the
Assistant Secretary for Indian Health.
(d) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended--
(A) by striking the following:
``Assistant Secretaries of Health and Human Services
(6).''; and
(B) by inserting the following:
``Assistant Secretaries of Health and Human Services
(7).''.
(2) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking the following:
``Director, Indian Health Service, Department of Health and
Human Services.''.
(e) Duties of Assistant Secretary for Indian Health.--
Section 601(a) of the Indian Health Care Improvement Act (25
U.S.C. 1661(a)) is amended--
(1) by inserting ``(1)'' after ``(a)'';
(2) in the second sentence of paragraph (1), as so
designated, by striking ``a Director,'' and inserting ``the
Assistant Secretary for Indian Health,''; and
(3) by striking the third sentence of paragraph (1) and all
that follows through the end of the subsection and inserting
the following: ``The Assistant Secretary for Indian Health
shall carry out the duties specified in paragraph (2).
``(2) The Assistant Secretary for Indian Health shall--
``(A) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian health;
``(B) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
``(C) advise each Assistant Secretary of the Department of
Health and Human Services concerning matters of Indian health
with respect to which that Assistant Secretary has authority
and responsibility;
``(D) advise the heads of other agencies and programs of
the Department of Health and Human Services concerning
matters of Indian health with respect to which those heads
have authority and responsibility; and
``(E) coordinate the activities of the Department of Health
and Human Services concerning matters of Indian health.''.
(f) Continued Service by Incumbent.--The individual serving
in the position of Director of the Indian Health Service on
the date preceding the date of enactment of this Act may
serve as Assistant Secretary for Indian Health, at the
pleasure of the President after the date of enactment of this
Act.
(g) Conforming Amendments.--
(1) Amendments to indian health care improvement act.--The
Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.)
is amended--
(A) in section 601--
(i) in subsection (c), by striking ``Director of the Indian
Health Service'' both places it appears and inserting
``Assistant Secretary for Indian Health''; and
(ii) in subsection (d), by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''; and
(B) in section 816(c)(1), by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(2) Amendments to other provisions of law.--The following
provisions are each amended by striking ``Director of the
Indian

[[Page S902]]

Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health'':
(A) Section 203(a)(1) of the Rehabilitation Act of 1973.
(B) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377 (b) and (e)).
(C) Section 803B(d)(1) of the Native American Programs Act
of 1974 (42 U.S.C. 2991b-2(d)(1)).
____

Section-by-Section Analysis

Subsection (a) provides that the Office of Assistant
Secretary for Indian Health is established within the
Department of Health and Human Services.
Subsection (b) requires that the Assistant Secretary for
Indian Health shall perform functions designated by the
Secretary of Health and Human Services in addition to the
functions of the Director of Indian Health. The Assistant
Secretary for Indian Health shall report directly to the
Secretary of HHS and shall also consult with the Assistant
Secretary of Health and other Assistant Secretaries on all
matters pertaining to Indian health policy.
Subsection (c) provides that any references to the Director
of Indian Health Service in any other Federal law, Executive
order, rule, regulation, or delegation of authority, or any
document shall be deemed to refer to the Assistant Secretary
for Indian Health.
Subsection (d)(1) amends Title 5 section 5315 of the U.S.C.
by striking ``Assistant Secretaries of Health and Human
Services (6)'' and inserting ``Assistant Secretaries of
Health and Human Services (7).'' Subsection (d)(1) further
amends 5316 of title 5 by striking ``Director, Indian Health
Service, Department of Health and Human Services.''
Subsection (d)(2) abolishes the position of the Director of
Indian Health Service.
Subsection (e) amends section 601 of the Indian Health Care
Improvement Act, 25 U.S.C. 1661, and other Acts by deleting
all provisions referring to the ``Director'' or ``Director of
Indian Health Service'' and inserting in lieu thereof ``the
Assistant Secretary for Indian Health.''
Subsection 601 of 25 U.S.C. 1661(a), as amended by
subsection (b), is further amended by striking the term
limits for the Assistant Secretary for Indian Health.<bullet>
______

By Mr. LOTT (for himself, Mr. Nickles, Ms. Collins, Mr. Frist,
Mr. Gramm, Mr. Hagel, Mr. Jeffords, Mr. Roth, Mr. Santorum, Mr.
Mack, Mr. Craig, Mr. Coverdell, Mr. McConnell, Mr. Abraham, Mr.
Allard, Mr. Ashcroft, Mr. Bennett, Mr. Bond, Mr. Brownback, Mr.
Bunning, Mr. Burns, Mr. Campbell, Mr. Cochran, Mr. DeWine, Mr.
Domenici, Mr. Enzi, Mr. Gorton, Mr. Grams, Mr. Grassley, Mr.
Gregg, Mr. Hatch, Mr. Helms, Mr. Hutchinson, Mrs. Hutchison,
Mr. Inhofe, Mr. Lugar, Mr. McCain, Mr. Murkowski, Mr. Roberts,
Mr. Sessions, Mr. Shelby, Mr. Smith of New Hampshire, Mr. Smith
of Oregon, Ms. Snowe, Mr. Stevens, Mr. Thomas, Mr. Thompson,
Mr. Thurmond, Mr. Voinovich, and Mr. Warner):
S. 300. A bill to improve access and choice of patients to quality,
affordable health care; to the Committee on Health, Education, Labor,
and Pensions.

Patients' Bill of Rights Plus Act

<bullet> Mr. NICKLES. Mr. President, today I am introducing the Senate
Republican Patients' Bill of Rights Plus. Joining me in this effort are
49 of my colleagues who recognize the importance of ensuring that all
Americans are able to not only receive the care they have been
promised, but also the highest quality of care available. The
foundation of this proposal is to address some of the very real
concerns that patients have about their health care needs and to
provide significant opportunities for all consumers in choosing their
doctors and health plans.
We know that many Americans have believed they were denied coverage
that their plans were supposed to cover. We recognize that some
individuals fear that their health care plans will not give them access
to specialists when they need them. We know that some Americans think
their health care plans care more about cost than they do about
quality.
Last January, the Majority Leader asked me to put together a group of
colleagues to address the issue of health care quality. For over eight
months, Senators Frist, Collins, Hagel, Roth, Jeffords, Coats,
Santorum, and Gramm worked tirelessly to put together a responsible,
credible package that would preserve what is best about our nation's
health care while at the same time determine ways to improve upon--
without stifling--the quality of care our nation delivers. We set out
to rationally examine the issues and develop reasonable solutions
without injuring patient access to affordable, high quality care.
This was no easy task. We spent month after month talking to experts
who understand the difficulty and complexity of our system. We met with
representatives from all aspects of the industry including the Mayo
Clinic, the Henry Ford Health Systems, the American Medical
Association, the American Hospital Association, the National Committee
for Quality Assurance, the Joint Commission on the Accreditation of
Healthcare Organizations, Corporate Medical Directors, Commissioners
from the President's Quality Commission, Purchasers, Families USA, the
Employee Benefit Research Institute, and many others.
After many, many months of dissecting serious questions about our
system, we determined that there were indeed some areas in which we
could improve patient access and quality.
Together, we have written an innovative plan that will answer the
problems that exist in the industry, while at the same time preserving
affordability, which is of utmost importance. After all, Mr. President,
I think you agree that if someone loses their health insurance because
a politician playing doctor drives prices to an unaffordable level, you
have hardly given them more rights or better quality health care.
We are proud of what we have been able to accomplish. For the first
time, patients can choose to be unencum- bered in their relationship
with their doctor. They will be able to choose their own doctor and get
the middle man out of the way. There will be no corporate bureaucrat,
no government bureaucrat and no lawyer standing between a patient and
their doctor. In addition our legislation does what no other bill has
done. It provides the patient with more choice in their health plans.
Mr. President the bill we introduce today:
Protects consumers in employer-sponsored plans that are exempt from
state regulation. People enrolled in such plans will have the right to:
Choose their doctors. Our bill contains both ``point-of-service'' and
``continuity of care'' requirements that will enhance consumer choice.
See their ob-gyns and pediatricians without referral. Guarantees
parents and families peace of mind by giving patients direct access to
pediatricians and ob-gyns without prior referral from a ``gatekeeper.''
Have a ``prudent layperson'' standard applied to their claims for
emergency care. Our bill will require health plans to cover--without
prior authorization--emergency care that a ``prudent layperson'' would
consider medically necessary.
Communicate openly with their doctors without ``gag'' clauses.
Holds health plans accountable for their decisions.
Extends to enrollees in ERISA health plans and their doctors the
right to appeal adverse coverage decisions to a physician who was not
involved in the initial coverage determination.
Allows enrollees to appeal adverse coverage determinations to
independent medical experts who have no affiliation with the health
plan. Determinations by these experts will be binding on the health
plan.
Requires health plans to disclose to enrollees consumer information,
including what's covered, what's not, how much they'll have to pay in
deductibles and coinsurance, and how to appeal adverse coverage
decisions to independent medical experts.
Guarantees consumers access to their medical records.
Requires health care providers, health plans, employers, health and
life insurers, and schools and universities to permit an individual to
inspect, copy and amend his or her own medical information.
Requires health care providers, health plans, health oversight
agencies, public health authorities, employers, health and life
insurers, health researchers, law enforcement officials, and schools
and universities to establish appropriate safeguards to protect the
confidentiality, security, accuracy and integrity of protected health
information and notify enrollees of these safeguards.

[[Page S903]]

Protects patients from genetic discrimination in health insurance.
Prohibits health plans from collecting or using predictive genetic
information about a patient to deny health insurance coverage or set
premium rates.
Promotes quality improvement by supporting research to give patients
and physicians better information regarding quality.
Establishes the Agency for Health- care Quality Research (AHQR),
whose purpose is to foster overall improvement in healthcare quality
and bridge the gap between what we know and what we do in healthcare
today. The Agency is built on the platform of the current Agency for
Health Care Policy and Research, but is refocused and enhanced to
become the hub and driving force of federal efforts to improve the
quality of healthcare in all practice environments--not just managed
care.
The role of the Agency is not to mandate a national definition of
quality, but to support the science necessary to provide information to
patients regarding the quality of the care they receive, to allow
physicians to compare their quality outcomes with their peers, and to
enable employers and individuals to be prudent purchasers based on
quality.
Makes health insurance more accessible and affordable by:
Allowing self-employed people to deduct the full amount of their
health care premiums.
Making medical savings accounts available to everyone.
Reforming flexibility spending accounts to let consumers save for
future health care costs.
Mr. President, this bill is a comprehensive bill of rights that will
benefit all Americans, and I am proud to join with so many of my
colleagues in introducing it. This legislation is built around several
basic principles which distinguishes it from other proposals.
First and foremost, it recognizes that regulation adds costs and not
value. The legislation places a priority on ensuring that we will not
increase the number of uninsured or make health care unaffordable
through excessive regulation.
Second, our legislation rightly places patients ahead of trial
lawyers. The inclusion of a strong, internal and external appeals
provision holds HMOs accountable, while guaranteeing that patients get
the care they need when they need it.
Third, our legislation protects the historic and traditional role of
states to regulate private health insurance. States are best equipped
to determine the needs of their citizens. Our legislation ensures that
the Federal Government and HCFA will not be empowered to expand their
reach into the private market. The creation of new federal
bureaucracies will only serve to stagnate and destroy what is best
about our health care system.
Finally, our legislation places a high priority on choice. Unlike
every other proposal our bill will give every American the right to
fire their HMO. Every patient will have their choice of doctor and
health plan.
Our bill empowers an independent medical expert to order an insurance
company to pay for medically necessary care so that patients suffer no
harm. Theirs allows professional trial lawyers to sue health plans
after harm is done.
Mr. President, when my insurance company tells me that they won't
cover a service for my family, I want the ability to appeal that
decision to a doctor who doesn't work for my insurance company. And I
want that appeal handled promptly, so that my family receives the
benefit. That is what our bill requires.
Other bills create new ways for trial lawyers to make money.
According to a June 1998 study by Multinational Business Services, the
Democrats' bill would create 56 new Federal causes of action--56 new
reasons to sue people in Federal court.
That's fine for trial lawyers, but it doesn't do much for patients.
Patients want their claim disputes handled promptly and fairly.
According to a study by the General Accounting Office, it takes an
average 25 months--more than two years--to resolve a malpractice suit.
One case that the GAO studied took 11 years to resolve! I'm sure the
lawyers who handled that case did quite well for themselves. But what
about the patient?
Under our bill, patients can appeal directly to an outside medical
expert for a prompt review of their claim--without having to incur any
legal expenses. In medical malpractice litigation, patients receive an
average of only 43 cents of every dollar awarded. The rest goes to
lawyers and court fees.
Our bill assures that health care dollars are used to serve patients.
It does not divert dollars away from patients and into the pockets of
trial lawyers.
Mr. President, another big difference between our bill and others
proposed is that their bill takes a ``big government'' approach to
health reform.
Our bill relies on State Insurance Commissioners to protect those
Americans who are enrolled in state-regulated plans. We protect the
unprotected by providing new federal safeguards to the 48 million
Americans who are enrolled in plans that the states are not permitted
to regulate.
Another problem: Some bills impose a risky and complicated scheme
that relies on federal bureaucrats at the Health Care Financing
Administration (HCFA) to enforce patients' rights in states that do not
conform to the federal mandates in their bill.
HCFA is the agency that oversees the federal Medicare and Medicaid
programs. Last year, in the Balanced Budget Act, Congress created new
consumer protections for Medicare beneficiaries--a ``Patients' Bill of
Rights'' for the 38.5 million senior citizens and disabled Americans
who rely on Medicare for their health care.
We asked HCFA to protect those rights. How have they done? I regret
to say, Mr. President, that they have not done very well at all.
On July 16, 1998, a GAO witness testified before the Ways and Means
Committee on how well HCFA was doing in implementing the Balanced
Budget Act and enforcing the Medicare patients' bill of rights.
According to GAO, HCFA has ``missed 25 percent of the implementation
deadlines, including the quality-of-care medical review process for
skilled nursing facilities. It is clear that HCFA will continue to miss
implementation deadlines as it attempts to balance the resource demands
generated by the Balanced Budget Act with other competing objectives.''
Mr. President, I won't detail all of the ways that HCFA has failed--
the fact that it is delaying implementation of a prostate screening
program to which Medicare beneficiaries are entitled, the fact that it
has failed to establish a quality-of-care medical review process for
skilled nursing facilities, the fact that it is far behind schedule in
developing a new payment system for home health services. The list goes
on and on.
But let me focus on one failure that is especially relevant. All of
us agree that people have the right to information about their health
plans. When they have the choice of more than one plan, accurate
information that compares the plans is critical.
Last year, Congress allocated $95 million to HCFA to develop an
information and education program for Medicare beneficiaries. This
money was to be used for publishing and mailing handbooks containing
comparative plan information to seniors, establishing a tool-free
number and Internet website, and sponsoring health information fairs.
Well, there haven't been any information fairs and the toll-free
number isn't operational. They do have a website, but they've decided
to mail comparative information handbooks only to seniors in 5 states:
Washington, Oregon, Ohio, Florida and Arizona. So for the pricey sum of
$95 million, only about 5.5 million seniors will receive important
information about their health plans, leaving 32.5 million seniors
without these handbooks. At that rate, HCFA would need more than $1
billion each year just for handbooks.
Mr. President, if this agency is struggling to protect the rights of
38.5 million Medicare beneficiaries, how can we ask it to protect the
rights of up to as many as 100 million people enrolled in private
health plans?
We believe that consumer protections are too important to entrust to
a cumbersome and inefficient federal government. State governments have
long been in the business of insurance regulation and the federal
government should not usurp their role.
One just has to look at HCFAs record on the Health Insurance and
Portability and Accountability Act

[[Page S904]]

(HIPAA). This Act gave HCFA enforcement authority in states that do not
meet federal health standards. But how has HCFA done in the enforcement
of HIPAA? A GAO report analyzing HCFA's success states that HCFA has
done very little in this area. HCFA's activities, to date, have been
``limited primarily to responding to consumer queries and complaints
and providing guidance'' to carriers in 4 of the 5 states that are not
in compliance.
The GAO report goes on to say that even HCFA admits ``the agency has
thus far pursued a ``Band Aid'' or minimalist approach to regulating
HIPAA. The failure to fully address this regulatory responsibility is
due to the fact that HCFA lacks the ``appropriate experience'' in the
regulating of the private health insurance market.
The federal government should protect those who are enrolled in plans
that are exempt from state regulation and those enrolled in the
programs it runs, like Medicare and Medicaid. The federal government
should start protecting the rights of senior citizens under Medicare,
instead of meddling in areas where it doesn't belong.
Mr. President, our bill is a truly comprehensive bill of rights for
patients, providing new consumer protections for the 48 million
Americans who are unprotected by state law, giving the 124 million
Americans enrolled in employer-sponsored plans new rights to appeal
adverse coverage decisions, protecting the civil rights of consumers to
gain access to their medical records, protecting consumers against
discrimination based on genetic tests, promoting quality improvement,
establishing a new women's health initiative, and giving millions of
Americans access to affordable health insurance through medical savings
accounts.
The doctor-patient relationship is one of the most important in
people's lives. Our legislation preserves and protects that
relationship, while taking many common-sense steps forward to affirm
and expand quality and access.
I look forward to a deliberative, thoughtful process this year on
examining the complex issues addressed in our Patients Bill of Rights
PLUS. Last year, the debate surrounding this legislation was extremely
politicized and resulted in a partisan standoff. That was unfortunate.
I am hopeful that the Committees will work this year to examine these
issues completely and substantively. Health care costs are rising
everyday, Mr. President. We must balance the need to protect patients
with the need to make health care accessible. The Committees will need
to examine the current trends in the market place and evaluate any
legislation on all fronts, not just political rhetoric. Health care is
just too important to politicize.
Mr. President, I ask unanimous consent that the text of the bill and
a summary be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 300

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Patients'
Bill of Rights Plus Act''.
(b) Table Of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.

TITLE I--PATIENTS' BILL OF RIGHTS

Subtitle A--Right to Advice and Care

Sec. 101. Patient right to medical advice and care.

``SUBPART C--PATIENT RIGHT TO MEDICAL ADVICE AND CARE

``Sec. 721. Patient access to emergency medical care.
``Sec. 722. Offering of choice of coverage options.
``Sec. 723. Patient access to obstetric and gynecological care.
``Sec. 724. Patient access to pediatric care.
``Sec. 725. Continuity of care.
``Sec. 726. Protection of patient-provider communications.
``Sec. 727. Generally applicable provision.
Sec. 102. Effective date and related rules.

Subtitle B--Right to Information About Plans and Providers

Sec. 111. Information about plans.
Sec. 112. Information about providers.

Subtitle C--Right to Hold Health Plans Accountable

Sec. 121. Amendment to Employee Retirement Income Security Act of 1974.

Subtitle D--Miscellaneous Provisions

Sec. 131. Amendments to the Internal Revenue Code of 1986.

TITLE II--INDIVIDUAL RIGHTS WITH RESPECT TO PERSONAL MEDICAL
INFORMATION

Sec. 201. Short title.

Subtitle A--Access to Medical Records

Sec. 211. Inspection and copying of protected health information.
Sec. 212. Amendment of protected health information.
Sec. 213. Notice of confidentiality practices.

Subtitle B--Establishment of Safeguards

Sec. 221. Establishment of safeguards.

Subtitle C--Enforcement; Definitions

Sec. 231. Civil penalty.
Sec. 232. Definitions.
Sec. 233. Effective date.

TITLE III--GENETIC INFORMATION AND SERVICES

Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of
1974.
Sec. 303. Amendments to the Public Health Service Act.
Sec. 304. Amendments to the Internal Revenue Code of 1986.

TITLE IV--HEALTHCARE RESEARCH AND QUALITY

Sec. 401. Short title.
Sec. 402. Amendment to the Public Health Service Act.

``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

``Part A--Establishment and General Duties

``Sec. 901. Mission and duties.
``Sec. 902. General authorities.

``Part B--Healthcare Improvement Research

``Sec. 911. Healthcare outcome improvement research.
``Sec. 912. Private-public partnerships to improve organization and
delivery.
``Sec. 913. Information on quality and cost of care.
``Sec. 914. Information systems for healthcare improvement.
``Sec. 915. Research supporting primary care and access in underserved
areas.
``Sec. 916. Clinical practice and technology innovation.
``Sec. 917. Coordination of Federal Government quality improvement
efforts.

``Part C--General Provisions

``Sec. 921. Advisory Council for Healthcare Research and Quality.
``Sec. 922. Peer review with respect to grants and contracts.
``Sec. 923. Certain provisions with respect to development, collection,
and dissemination of data.
``Sec. 924. Dissemination of information.
``Sec. 925. Additional provisions with respect to grants and contracts.
``Sec. 926. Certain administrative authorities.
``Sec. 927. Funding.
``Sec. 928. Definitions.
Sec. 403. References.
Sec. 404. Study.

TITLE V--ENHANCED ACCESS TO HEALTH INSURANCE COVERAGE

Sec. 501. Full deduction of health insurance costs for self-employed
individuals.
Sec. 502. Full availability of medical savings accounts.
Sec. 503. Carryover of unused benefits from cafeteria plans, flexible
spending arrangements, and health flexible spending
accounts.
Sec. 504. Permitting contribution towards medical savings account
through Federal employees health benefits program
(FEHBP).
TITLE I--PATIENTS' BILL OF RIGHTS
Subtitle A--Right to Advice and Care

SEC. 101. PATIENT RIGHT TO MEDICAL ADVICE AND CARE.

(a) In General.--Part 7 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185 et seq.) is amended--
(1) by redesignating subpart C as subpart D; and
(2) by inserting after subpart B the following:

``Subpart C--Patient Right to Medical Advice and Care

``SEC. 721. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

``(a) In General.--To the extent that the group health plan
(other than a fully insured group health plan) provides
coverage for benefits consisting of emergency medical care
(as defined in subsection (c)), except for items or
services specifically excluded--
``(1) the plan shall provide coverage for benefits, without
requiring preauthorization, for appropriate emergency medical
screening examinations (within the capability of the
emergency facility, including ancillary services routinely
available to the emergency facility) to the extent that a
prudent layperson, who possesses an average knowledge of
health and medicine, would determine such examinations to be
necessary to determine whether emergency medical care (as so
defined) is necessary, and
``(2) the plan shall provide coverage for benefits for
additional emergency medical

[[Page S905]]

care to stabilize an emergency medical condition following an
emergency medical screening examination (if determined
necessary under paragraph (1)), pursuant to the definition of
stabilize under section 1867(e)(3) of the Social Security Act
(42 U.S.C. 1395dd(e)(3)).
``(b) Uniform Cost-Sharing Required.--Nothing in this
section shall be construed as preventing a group health plan
(other than a fully insured group health plan) from imposing
any form of cost-sharing applicable to any participant or
beneficiary (including coinsurance, copayments, deductibles,
and any other charges) in relation to coverage for benefits
described in subsection (a), if such form of cost-sharing is
uniformly applied under such plan, with respect to similarly
situated participants and beneficiaries, to all benefits
consisting of emergency medical care (as defined in
subsection (c)) provided to such similarly situated
participants and beneficiaries under the plan.
``(c) Definition of Emergency Medical Care.--In this
section:
``(1) In general.--The term ``emergency medical care''
means, with respect to a participant or beneficiary under a
group health plan (other than a fully insured group health
plan), covered inpatient and outpatient services that--
``(A) are furnished by any provider, including a
nonparticipating provider, that is qualified to furnish such
services; and
``(B) are needed to evaluate or stabilize (as such term is
defined in section 1867(e)(3) of the Social Security Act (42
U.S.C. 1395dd)) an emergency medical condition (as defined in
paragraph (2)).
``(2) Emergency medical condition.--The term ``emergency
medical condition'' means a medical condition manifesting
itself by acute symptoms of sufficient severity (including
severe pain) such that a prudent layperson, who possesses an
average knowledge of health and medicine, could reasonably
expect the absence of immediate medical attention to result
in--
``(A) placing the health of the participant or beneficiary
(or, with respect to a pregnant woman, the health of the
woman or her unborn child) in serious jeopardy,
``(B) serious impairment to bodily functions, or
``(C) serious dysfunction of any bodily organ or part.

``SEC. 722. OFFERING OF CHOICE OF COVERAGE OPTIONS.

``(a) Requirement.--
``(1) Offering of point-of-service coverage option.--Except
as provided in paragraph (2), if a group health plan (other
than a fully insured group health plan) provides coverage for
benefits only through a defined set of participating health
care professionals, the plan shall offer the participant the
option to purchase point-of-service coverage (as defined in
subsection (b)) for all such benefits for which coverage is
otherwise so limited. Such option shall be made available to
the participant at the time of enrollment under the plan and
at such other times as the plan offers the participant a
choice of coverage options.
``(2) Exception in the case of multiple issuer or coverage
options.--Paragraph (1) shall not apply with respect to a
participant in a group health plan (other than a fully
insured group health plan) if the plan offers the
participant--
``(A) a choice of health insurance coverage through more
than one health insurance issuer; or
``(B) two or more coverage options that differ
significantly with respect to the use of participating health
care professionals or the networks of such professionals that
are used.
``(b) Point-of-Service Coverage Defined.--In this section,
the term `point-of-service coverage' means, with respect to
benefits covered under a group health plan (other than a
fully insured group health plan), coverage of such benefits
when provided by a nonparticipating health care professional.
``(c) Small Employer Exemption.--
``(1) In general.--This section shall not apply to any
group health plan (other than a fully insured group health
plan) of a small employer.
``(2) Small employer.--For purposes of paragraph (1), the
term `small employer' means, in connection with a group
health plan (other than a fully insured group health plan)
with respect to a calendar year and a plan year, an employer
who employed an average of at least 2 but not more than 50
employees on business days during the preceding calendar year
and who employs at least 2 employees on the first day of the
plan year. For purposes of this paragraph, the provisions of
subparagraph (C) of section 712(c)(1) shall apply in
determining employer size.
``(d) Rule of Construction.--Nothing in this section shall
be construed--
``(1) as requiring coverage for benefits for a particular
type of health care professional;
``(2) as requiring an employer to pay any costs as a result
of this section or to make equal contributions with respect
to different health coverage options;
``(3) as preventing a group health plan (other than a fully
insured group health plan) from imposing higher premiums or
cost-sharing on a participant for the exercise of a point-of-
service coverage option; or
``(4) to require that a group health plan (other than a
fully insured group health plan) include coverage of health
care professionals that the plan excludes because of fraud,
quality of care, or other similar reasons with respect to
such professionals.

``SEC. 723. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL
CARE.

``(a) In General.--In any case in which a group health plan
(other than a fully insured group health plan)--
``(1) provides coverage for benefits consisting of--
``(A) gynecological care (such as preventive women's health
examinations); or
``(B) obstetric care (such as pregnancy-related services);
provided by a participating physician who specializes in such
care; and
``(2) requires or provides for designation by a participant
or beneficiary of a participating primary care provider;
if the primary care provider designated by such a participant
or beneficiary is not such a physician as described in
paragraph (1), then the plan shall meet the requirements of
subsection (b).
``(b) Requirements.--A group health plan (other than a
fully insured group health plan) meets the requirements of
this subsection, in connection with the coverage of benefits
described in subsection (a) consisting of care described in
subparagraph (A) or (B) of subsection (a)(1), if the plan--
``(1) does not require authorization or a referral by the
primary care provider in order to obtain coverage for such
benefits, and
``(2) treats the ordering of other routine care related to
the care described in subparagraph (A) or (B) of subsection
(a)(1), by the participating physician providing the care
described in either such subparagraph, as the authorization
of the primary care provider with respect to such care.
``(c) Rule of Construction.--Nothing in subsection (b)(2)
shall waive any requirements of coverage relating to medical
necessity or appropriateness with respect to coverage of
gynecological or obstetric care so ordered. Nothing in
subsection (b) shall be construed to preclude the health plan
from requiring that the obstetrician or gynecologist notify
the primary care provider or the plan of treatment decisions.

``SEC. 724. PATIENT ACCESS TO PEDIATRIC CARE.

``(a) In General.--In any case in which a group health plan
(other than a fully insured group health plan)--
``(1) provides coverage for benefits consisting of
pediatric care by a participating pediatrician; and
``(2) requires or provides for designation by a participant
or beneficiary of a participating primary care provider;
if the primary care provider designated by such a participant
or beneficiary is not a physician as described in paragraph
(1), then the plan shall meet the requirements of subsection
(b).
``(b) Requirements.--A group health plan (other than a
fully insured group health plan) meets the requirements of
this subsection, in connection with the coverage of benefits
described in subsection (a) consisting of care described in
subsection (a)(1), if the plan--
``(1) does not require authorization or a referral by the
primary care provider in order to obtain coverage for such
benefits, and
``(2) treats the ordering of other routine care of the same
type, by the participating physician providing the care
described in subsection (a)(1), as the authorization of the
primary care provider with respect to such care.
``(c) Construction.--Nothing in subsection (b)(2) shall
waive any requirements of coverage relating to medical
necessity or appropriateness with respect to coverage of
pediatric care so ordered.

``SEC. 725. CONTINUITY OF CARE.

``(a) In General.--
``(1) Termination of provider.--If a contract between a
group health plan (other than a fully insured group health
plan) and a health care provider is terminated (as defined in
paragraph (2)), or benefits or coverage provided by a health
care provider are terminated because of a change in the terms
of provider participation in such group health plan, and an
individual who is a participant or beneficiary in the plan is
undergoing a course of treatment from the provider at the
time of such termination, the plan shall--
``(A) notify the individual on a timely basis of such
termination;
``(B) provide the individual with an opportunity to notify
the plan of a need for transitional care; and
``(C) in the case of termination described in paragraph
(2), (3), or (4) of subsection (b), and subject to subsection
(c), permit the individual to continue or be covered with
respect to the course of treatment with the provider's
consent during a transitional period (as provided under
subsection (b)).
``(2) Terminated.--In this section, the term `terminated'
includes, with respect to a contract, the expiration or
nonrenewal of the contract by the group health plan, but does
not include a termination of the contract by the plan for
failure to meet applicable quality standards or for fraud.
``(3) Contracts.--For purposes of this section, the term
`contract between a group health plan (other than a fully
insured group health plan) and a health care provider' shall
include a contract between such a plan and an organized
network of providers.
``(b) Transitional Period.--
``(1) General rule.--Except as provided in paragraph (3),
the transitional period under this subsection shall extend
for up to 90 days from the date of the notice described in
subsection (a)(1)(A) of the provider's termination.

[[Page S906]]

``(2) Institutional care.--Subject to paragraph (1), the
transitional period under this subsection for institutional
or inpatient care from a provider shall extend until the
discharge or termination of the period of
institutionalization and also shall include institutional
care provided within a reasonable time of the date of
termination of the provider status if the care was scheduled
before the date of the announcement of the termination of the
provider status under subsection (a)(1)(A) or if the
individual on such date was on an established waiting list or
otherwise scheduled to have such care.
``(3) Pregnancy.--Notwithstanding paragraph (1), if--
``(A) a participant or beneficiary has entered the second
trimester of pregnancy at the time of a provider's
termination of participation; and
``(B) the provider was treating the pregnancy before the
date of the termination;
the transitional period under this subsection with respect to
provider's treatment of the pregnancy shall extend through
the provision of post-partum care directly related to the
delivery.
``(4) Terminal illness.--Subject to paragraph (1), if--
``(A) a participant or beneficiary was determined to be
terminally ill (as determined under section 1861(dd)(3)(A) of
the Social Security Act) prior to a provider's termination of
participation; and
``(B) the provider was treating the terminal illness before
the date of termination;
the transitional period under this subsection shall be for
care directly related to the treatment of the terminal
illness.
``(c) Permissible Terms and Conditions.--A group health
plan (other than a fully insured group health plan) may
condition coverage of continued treatment by a provider under
subsection (a)(1)(B) upon the provider agreeing to the
following terms and conditions:
``(1) The provider agrees to accept reimbursement from the
plan and individual involved (with respect to cost-sharing)
at the rates applicable prior to the start of the
transitional period as payment in full (or, in the case
described in subsection (b)(2), at the rates applicable under
the replacement plan after the date of the termination of the
contract with the group health plan) and not to impose cost-
sharing with respect to the individual in an amount that
would exceed the cost-sharing that could have been imposed if
the contract referred to in subsection (a)(1) had not been
terminated.
``(2) The provider agrees to adhere to the quality
assurance standards of the plan responsible for payment under
paragraph (1) and to provide to such plan necessary medical
information related to the care provided.
``(3) The provider agrees otherwise to adhere to such
plan's policies and procedures, including procedures
regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan (if any)
approved by the plan.
``(d) Rule of Construction.--Nothing in this section shall
be construed to require the coverage of benefits which would
not have been covered if the provider involved remained a
participating provider.
``(e) Definition.--In this section, the term `health care
provider' or `provider' means--
``(1) any individual who is engaged in the delivery of
health care services in a State and who is required by State
law or regulation to be licensed or certified by the State to
engage in the delivery of such services in the State; and
``(2) any entity that is engaged in the delivery of health
care services in a State and that, if it is required by State
law or regulation to be licensed or certified by the State to
engage in the delivery of such services in the State, is so
licensed.

``SEC. 726. PROTECTION OF PATIENT-PROVIDER COMMUNICATIONS.

``(a) In General.--Subject to subsection (b), a group
health plan (other than a fully insured group health plan and
in relation to a participant or beneficiary) shall not
prohibit or otherwise restrict a health care professional
from advising such a participant or beneficiary who is a
patient of the professional about the health status of the
participant or beneficiary or medical care or treatment for
the condition or disease of the participant or beneficiary,
regardless of whether coverage for such care or treatment are
provided under the contract, if the professional is acting
within the lawful scope of practice.
``(b) Rule of Construction.--Nothing in this section shall
be construed as requiring a group health plan (other than a
fully insured group health plan) to provide specific benefits
under the terms of such plan.

``SEC. 727. GENERALLY APPLICABLE PROVISION.

``In the case of a group health plan that provides benefits
under 2 or more coverage options, the requirements of
sections 721, 723, 724, 725 and 726 shall apply separately
with respect to each coverage option.''.
(b) Rule With Respect to Certain Plans.--
(1) In general.--Notwithstanding any other provision of
law, health insurance issuers may offer, and eligible
individuals may purchase, high deductible health plans
described in section 220(c)(2)(A) of the Internal Revenue
Code of 1986. Effective for the 4-year period beginning on
the date of the enactment of this Act, such health plans
shall not be required to provide payment for any health care
items or services that are exempt from the plan's deductible.
(2) Existing state laws.--A State law relating to payment
for health care items and services in effect on the date of
enactment of this Act that is preempted under paragraph (1),
shall not apply to high deductible health plans after the
expiration of the 4-year period described in such paragraph
unless the State reenacts such law after such period.
(c) Definition.--Section 733(a) of the Employee Retirement
Income Security Act of 1974 (42 U.S.C. 1186(a)) is amended by
adding at the end the following:
``(3) Fully insured group health plan.--The term `fully
insured group health plan' means a group health plan where
benefits are provided pursuant to the terms of an arrangement
between a group health plan and a health insurance issuer and
are guaranteed by the health insurance issuer under a
contract or policy of insurance.''.
(d) Conforming Amendment.--The table of contents in section
1 of such Act is amended--
(1) in the item relating to subpart C, by striking
``Subpart C'' and inserting ``Subpart D''; and
(2) by adding at the end of the items relating to subpart B
of part 7 of subtitle B of title I of such Act the following
new items:

``Subpart C--Patient Right to Medical Advice and Care

SEC. 102. EFFECTIVE DATE AND RELATED RULES.

(a) In General.--The amendments made by this subtitle shall
apply with respect to plan years beginning on or after
January 1 of the second calendar year following the date of
the enactment of this Act. The Secretary shall issue all
regulations necessary to carry out the amendments made by
this section before the effective date thereof.
(b) Limitation on Enforcement Actions.--No enforcement
action shall be taken, pursuant to the amendments made by
this subtitle, against a group health plan with respect to a
violation of a requirement imposed by such amendments before
the date of issuance of regulations issued in connection with
such requirement, if the plan has sought to comply in good
faith with such requirement.
Subtitle B--Right to Information About Plans and Providers

SEC. 111. INFORMATION ABOUT PLANS.

(a) In General.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974, as
amended by the Omnibus Consolidated and Emergency
Supplemental Appropriations Act, 1999 (Public Law 105-277),
is amended by adding at the end the following:

``SEC. 714. HEALTH PLAN COMPARATIVE INFORMATION.

``(a) Requirement.--A group health plan, or health
insurance issuer in connection with group health insurance
coverage, shall, not later than 12 months after the date of
enactment of this section, provide for the disclosure, in a
clear and accurate form to each enrollee, or upon request to
a potential enrollee eligible to receive benefits under the
plan, or plan sponsor with which the plan or issuer has
contracted, of the information described in subsection (b).
``(b) Required Information.--The informational materials to
be distributed under this section shall include for each
health benefit plan the following:
``(1) A description of the covered items and services under
each such plan and any in- and out-of-network features of
each such plan.
``(2) A description of any cost-sharing, including
premiums, deductibles, coinsurance, and copayment amounts,
for which the enrollee will be responsible, including any
annual or lifetime limits on benefits, for each such plan.
``(3) A description of any optional supplemental benefits
offered by each such plan and the terms and conditions
(including premiums or cost-sharing) for such supplemental
coverage.
``(4) A description of any restrictions on payments for
services furnished to an enrollee by a health care
professional that is not a participating professional and the
liability of the enrollee for additional payments for these
services.
``(5) A description of the service area of each such plan,
including the provision of any out-of-area coverage.
``(6) A description of the extent to which enrollees may
select the primary care provider of their choice, including
providers both within the network and outside the network of
each such plan (if the plan permits out-of-network services).
``(7) A description of the procedures for advance
directives and organ donation decisions if the plan maintains
such procedures.
``(8) A description of the requirements and procedures to
be used to obtain preauthorization for health services
(including telephone numbers and mailing addresses),
including referrals for specialty care.
``(9) A summary of the rules and methods for appealing
coverage decisions and filing grievances (including telephone
numbers and mailing addresses), as well as other available
remedies.
``(10) A summary of the rules for access to emergency room
care. Also, any available

[[Page S907]]

educational material regarding proper use of emergency
services.
``(11) A description of whether or not coverage is provided
for experimental treatments, investigational treatments, or
clinical trials and the circumstances under which access to
such treatments or trials is made available.
``(12) A description of the specific preventative services
covered under the plan if such services are covered.
``(13) A statement regarding--
``(A) the manner in which an enrollee may access an
obstetrician, gynecologist, or pediatrician in accordance
with section 723 or 724;
``(B) the manner in which an enrollee obtains continuity of
care as provided for in section 725; and
``(C) the manner in which an enrollee has access to the
medical records of the enrollee in accordance with subtitle A
of title II of the Patients' Bill of Rights Plus Act.
``(14) A statement that the following information, and
instructions on obtaining such information (including
telephone numbers and, if available, Internet websites),
shall be made available upon request:
``(A) The names, addresses, telephone numbers, and State
licensure status of the plan's participating health care
professionals and participating health care facilities, and,
if available, the education, training, speciality
qualifications or certifications of such professionals.
``(B) A summary description of the methods used for
compensating participating health care professionals, such as
capitation, fee-for-service, salary, or a combination
thereof. The requirement of this subparagraph shall not be
construed as requiring plans to provide information
concerning proprietary payment methodology.
``(C) A summary description of the methods used for
compensating health care facilities, including per diem, fee-
for-service, capitation, bundled payments, or a combination
thereof. The requirement of this subparagraph shall not be
construed as requiring plans to provide information
concerning proprietary payment methodology.
``(D) A summary description of the procedures used for
utilization review.
``(E) The list of the specific prescription medications
included in the formulary of the plan, if the plan uses a
defined formulary, and any provision for obtaining off-
formulary medications.
``(F) A description of the specific exclusions from
coverage under the plan.
``(G) Any available information related to the availability
of translation or interpretation services for non-English
speakers and people with communication disabilities,
including the availability of audio tapes or information in
Braille.
``(H) Any information that is made public by accrediting
organizations in the process of accreditation if the plan is
accredited, or any additional quality indicators that the
plan makes available.
``(c) Manner of Distribution.--
``(1) In general.--The information described in this
section shall be distributed in an accessible format that is
understandable to an average plan enrollee.
``(2) Rule of construction.--For purposes of this section,
a group health plan, or health insurance issuer in connection
with group health insurance coverage, in reliance on records
maintained by the plan or issuer, shall be deemed to have met
the requirements of this section if the plan or issuer
provides the information requested under this section--
``(A) in the case of the plan, to participants and
beneficiaries at the address contained in such records with
respect to such participants and beneficiaries; or
``(B) in the case of the issuer, to the employer of a
participant if the employer provides for the coverage of such
participant under the plan involved or to participants and
beneficiaries at the address contained in such records with
respect to such participants and beneficiaries.
``(d) Rule of Construction.--Nothing in this section may be
construed to prohibit a group health plan, or health
insurance issuer in connection with group health insurance
coverage, from distributing any other additional information
determined by the plan or issuer to be important or necessary
in assisting participants and beneficiaries enrollees or upon
request potential participants in the selection of a health
plan or from providing information under subsection (b)(13)
as part of the required information.
``(e) Health Care Professional.--In this section, the term
`health care professional' means a physician (as defined in
section 1861(r) of the Social Security Act) or other health
care professional if coverage for the professional's services
is provided under the health plan involved for the services
of the professional. Such term includes a podiatrist,
optometrist, chiropractor, psychologist, dentist, physician
assistant, physical or occupational therapist and therapy
assistant, speech-language pathologist, audiologist,
registered or licensed practical nurse (including nurse
practitioner, clinical nurse specialist, certified registered
nurse anesthetist, and certified nurse-midwife), licensed
certified social worker, registered respiratory therapist,
and certified respiratory therapy technician.''.
(b) Conforming Amendments.--
(1) Section 732(a) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185(a)) is amended by
striking ``section 711, and inserting ``sections 711 and
714''.
(2) The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001) is
amended by inserting after the item relating to section 713,
the following:
``Sec. 714. Health plan comparative information.''.

SEC. 112. INFORMATION ABOUT PROVIDERS.

(a) Study.--The Secretary of Health and Human Services
shall enter into a contract with the Institute of Medicine
for the conduct of a study, and the submission to the
Secretary of a report, that includes--
(1) an analysis of information concerning health care
professionals that is currently available to patients,
consumers, States, and professional societies, nationally and
on a State-by-State basis, including patient preferences with
respect to information about such professionals and their
competencies;
(2) an evaluation of the legal and other barriers to the
sharing of information concerning health care professionals;
and
(3) recommendations for the disclosure of information on
health care professionals, including the competencies and
professional qualifications of such practitioners, to better
facilitate patient choice, quality improvement, and market
competition.
(b) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall forward to the appropriate committees of
Congress a copy of the report and study conducted under
subsection (a).
Subtitle C--Right to Hold Health Plans Accountable

SEC. 121. AMENDMENT TO EMPLOYEE RETIREMENT INCOME SECURITY
ACT OF 1974.

(a) In General.--Section 503 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1133) is amended to
read as follows:

``SEC. 503. CLAIMS PROCEDURE, COVERAGE DETERMINATION,
GRIEVANCES AND APPEALS.

``(a) Claims Procedure.--In accordance with regulations of
the Secretary, every employee benefit plan shall--
``(1) provide adequate notice in writing to any participant
or beneficiary whose claim for benefits under the plan has
been denied, setting forth the specific reasons for such
denial, written in a manner calculated to be understood by
the participant, and
``(2) afford a reasonable opportunity to any participant
whose claim for benefits has been denied for a full and fair
review by the appropriate named fiduciary of the decision
denying the claim.
``(b) Coverage Determinations Under Group Health Plans.--
``(1) Procedures.--
``(A) In general.--A group health plan or health insurance
issuer conducting utilization review shall ensure that
procedures are in place for--
``(i) making determinations regarding whether an enrollee
is eligible to receive a payment or coverage for health
services under the plan or coverage involved and any cost-
sharing amount that the enrollee is required to pay with
respect to such service;
``(ii) notifying covered enrollees (or the legal
representative of such enrollees) and the treating health
care professionals involved regarding determinations made
under the plan or issuer and any additional payments that the
enrollee may be required to make with respect to such
service; and
``(iii) responding to requests, either written or oral, for
coverage determinations or for internal appeals from an
enrollee (or the legal representative of such enrollee) or
the treating health care professional.
``(B) Oral requests.--With respect to an oral request
described in subparagraph (A)(iii), a group health plan or
health insurance issuer may require that the requesting
individual provide written evidence of such request.
``(2) Timeline for making determinations.--
``(A) Routine determination.--A group health plan or a
health insurance issuer shall maintain procedures to ensure
that prior authorization determinations concerning the
provision of non-emergency items or services are made within
30 days from the date on which the request for a
determination is submitted, except that such period may be
extended where certain circumstances exist that are
determined by the Secretary to be beyond control of the plan
or issuer.
``(B) Expedited determination.--
``(i) In general.--A prior authorization determination
under this subsection shall be made within 72 hours after a
request is received by the plan or issuer under clause (ii)
or (iii).
``(ii) Request by enrollee.--A plan or issuer shall
maintain procedures for expediting a prior authorization
determination under this subsection upon the request of an
enrollee if, based on such a request, the plan or issuer
determines that the normal time for making such a
determination could seriously jeopardize the life or health
of the enrollee.
``(iii) Documentation by health care professional.--A plan
or issuer shall maintain procedures for expediting a prior
authorization determination under this subsection if the
request involved indicates that the treating health care
professional has documented, based on the medical exigencies,
that a determination under the procedures described in
subparagraph (A) could seriously jeopardize the life or
health of the enrollee.

[[Page S908]]

``(C) Concurrent determinations.--A plan or issuer shall
maintain procedures to certify or deny coverage of an
extended stay or additional services.
``(D) Retrospective determination.--A plan or issuer shall
maintain procedures to ensure that, with respect to the
retrospective review of a determination made under paragraph
(1), the determination shall be made within 30 working days
of the date on which the plan or issuer receives all
necessary information.
``(3) Notice of determinations.--
``(A) Routine determination.--With respect to a coverage
determination of a plan or issuer under paragraph (2)(A), the
plan or issuer shall issue notice of such determination to
the enrollee (or the legal representative of the enrollee),
and consistent with the medical exigencies of the case, to
the treating health care professional involved not later than
2 working days after the date on which the determination is
made.
``(B) Expedited determination.--With respect to a coverage
determination of a plan or issuer under paragraph (2)(B), the
plan or issuer shall issue notice of such determination to
the enrollee (or the legal representative of the enrollee),
and consistent with the medical exigencies of the case, to
the treating health care professional involved within the 72
hour period described in paragraph (2)(B).
``(C) Concurrent reviews.--With respect to the
determination under a plan or issuer under paragraph (1) to
certify or deny coverage of an extended stay or additional
services, the plan or issuer shall issue notice of such
determination to the treating health care professional and to
the enrollee involved (or the legal representative of the
enrollee) within 1 working day of the date on which the
initial notice was issued.
``(D) Retrospective reviews.--With respect to the
retrospective review under a plan or issuer of a
determination made under paragraph (1), a determination shall
be made within 30 working days of the date on which the plan
or issuer receives all necessary information. The plan or
issuer shall issue written notice of an approval or
disapproval of a determination under this subparagraph to the
enrollee (or the legal representative of the enrollee) and
health care provider involved within 5 working days of the
date on which such determination is made.
``(E) Requirements of notice of adverse coverage
determinations.--A written or electronic notice of an adverse
coverage determination under this subsection, or of an
expedited adverse coverage determination under paragraph
(2)(B), shall be provided to the enrollee (or the legal
representative of the enrollee) and treating health care
professional (if any) involved and shall include--
``(i) the reasons for the determination (including the
clinical or scientific-evidence based rationale used in
making the determination) written in a manner to be
understandable to the average enrollee;
``(ii) the procedures for obtaining additional information
concerning the determination; and
``(iii) notification of the right to appeal the
determination and instructions on how to initiate an appeal
in accordance with subsection (d).
``(c) Grievances.--A group health plan or a health
insurance issuer shall have written procedures for addressing
grievances between the plan and enrollees. Determinations
under such procedures shall be non-appealable.
``(d) Internal Appeal of Coverage Determinations.--
``(1) In general.--An enrollee (or the legal representative
of the enrollee) and the treating health care professional
with the consent of the enrollee (or the legal representative
of the enrollee), may appeal any adverse coverage
determination under subsection (b) under the procedures
described in this subsection.
``(2) Records.--A group health plan and a health insurance
issuer shall maintain written records, for at least 6 years,
with respect to any appeal under this subsection for purposes
of internal quality assurance and improvement.
``(3) Routine determinations.--A group health plan or a
health insurance issuer shall provide for the consideration
of an appeal of an adverse routine determination under this
subsection not later than 30 working days after the date on
which a request for such appeal is received.
``(4) Expedited determination.--
``(A) In general.--An expedited determination with respect
to an appeal under this subsection shall be made in
accordance with the medical exigencies of the case, but in no
case more than 72 hours after the request for such appeal is
received by the plan or issuer under subparagraph (B) or (C).
``(B) Request by enrollee.--A plan or issuer shall maintain
procedures for expediting a prior authorization determination
under this subsection upon the request of an enrollee if,
based on such a request, the plan or issuer determines that
the normal time for making such a determination could
seriously jeopardize the life or health of the enrollee.
``(C) Documentation by health care professional.--A plan or
issuer shall maintain procedures for expediting a prior
authorization determination under this subsection if the
request involved indicates that the treating health care
professional has documented, based on the medical exigencies
that a determination under the procedures described in
paragraph (2) could seriously jeopardize the life or health
of the enrollee.
``(5) Conduct of review.--A review of an adverse coverage
determination under this subsection shall be conducted by an
individual with appropriate expertise who was not involved in
the initial determination.
``(6) Lack of medical necessity.--A review of an appeal
under this subsection relating to a determination to deny
coverage based on a lack of medical necessity or
appropriateness, or based on an experimental or
investigational treatment, shall be made only by a physician
with appropriate expertise in the field of medicine involved
who was not involved in the initial determination.
``(7) Notice.--
``(A) In general.--Written notice of a determination made
under an internal review process shall be issued to the
enrollee (or the legal representative of the enrollee) and
the treating health care professional not later than 2
working days after the completion of the review (or within
the 72-hour period referred to in paragraph (4) if
applicable).
``(B) Adverse coverage determinations.--With respect to an
adverse coverage determination made under this subsection,
the notice described in subparagraph (A) shall include--
``(i) the reasons for the determination (including the
clinical or scientific-evidence based rationale used in
making the determination) written in a manner to be
understandable to the average enrollee;
``(ii) the procedures for obtaining additional information
concerning the determination; and
``(iii) notification of the right to an external review
under subsection (e) and instructions on how to initiate such
a review.
``(e) External Review.--
``(1) In general.--A group health plan or a health
insurance issuer shall have written procedures to permit an
enrollee (or the legal representative of the enrollee) access
to an external review with respect to a coverage
determination concerning a particular item or service where--
``(A) the particular item or service involved, when
medically appropriate and necessary, is a covered benefit
under the terms and conditions of the contract between the
plan or issuer and the enrollee;
``(B) the coverage determination involved denied coverage
for such item or service because the provision of such item
or service--
``(i) does not meet the plan's or issuer's requirements for
medical appropriateness or necessity and the amount involved
exceeds a significant financial threshold; or
``(ii) would constitute experimental or investigational
treatment and there is a significant risk of placing the life
or health of the enrollee in jeopardy; and
``(C) the enrollee has completed the internal appeals
process with respect to such determination.
``(2) Initiation of the external review process.--
``(A) Filing of request.--An enrollee (or the legal
representative of the enrollee) who desires to have an
external review conducted under this subsection shall file a
written request for such a review with the plan or issuer
involved not later than 30 working days after the receipt of
a final denial of a claim under subsection (d). Any such
request shall include the consent of the enrollee (or the
legal representative of the enrollee) for the release of
medical information and records to external reviewers
regarding the enrollee if such information is necessary for
the proper conduct of the external review.
``(B) Information and notice.--Not later than 5 working
days after the receipt of a request under subparagraph (A),
or earlier in accordance with the medical exigencies of the
case, the plan or issuer involved shall select an external
appeals entity under paragraph (3)(A) that shall be
responsible for designating an external reviewer under
paragraph (3)(B).
``(C) Provision of information.--The plan or issuer
involved shall forward all necessary information (including
medical records, any relevant review criteria, the clinical
rationale consistent with the terms and conditions of the
contract between the plan or issuer and the enrollee for the
coverage denial, and evidence of the enrollee's coverage) to
the external reviewer selected under paragraph (3)(B).
``(D) Notification.--The plan or issuer involved shall send
a written notification to the enrollee (or the legal
representative of the enrollee) and the plan administrator,
indicating that an external review has been initiated.
``(3) Conduct of external review.--
``(A) Designation of external appeals entity by plan or
issuer.--A plan or issuer that receives a request for an
external review under paragraph (2)(A) shall designate one of
the following entities to serve as the external appeals
entity:
``(i) An external review entity licensed or credentialed by
a State.
``(ii) A State agency established for the purpose of
conducting independent external reviews.
``(iii) Any entity under contract with the Federal
Government to provide external review services.
``(iv) Any entity accredited as an external review entity
by an accrediting body recognized by the Secretary for such
purpose.
``(v) Any fully accredited teaching hospital.
``(vi) Any other entity meeting criteria established by the
Secretary for purposes of this subparagraph.

[[Page S909]]

``(B) Designation of external reviewer by external appeals
entity.--The external appeals entity designated under
subparagraph (A) shall, not later than 30 days after the date
on which such entity is designated under subparagraph (A), or
earlier in accordance with the medical exigencies of the
case, designate one or more individuals to serve as external
reviewers with respect to a request receives under paragraph
(2)(A). Such reviewers shall be independent medical experts
who shall--
``(i) be appropriately credentialed or licensed in any
State to deliver health care services;
``(ii) not have any material, professional, familial, or
financial affiliation with the case under review, the
enrollee involved, the treating health care professional, the
institution where the treatment would take place, or the
manufacturer of any drug, device, procedure, or other therapy
proposed for the enrollee whose treatment is under review;
``(iii) be experts in the diagnosis or treatment under
review and, when reasonably available, be of the same
speciality of the physician prescribing the treatment in
question;
``(iv) receive only reasonable and customary compensation
from the group health plan or health insurance issuer in
connection with the external review that is not contingent on
the decision rendered by the reviewer; and
``(v) not be held liable for decisions regarding medical
determinations (but may be held liable for actions that are
arbitrary and capricious).
``(4) Standard of review.--
``(A) In general.--An external reviewer shall--
``(i) make a determination based on the medical necessity,
appropriateness, experimental or investigational nature of
the coverage denial;
``(ii) take into consideration any evidence-based decision
making or clinical practice guidelines used by the group
health plan or health insurance issuer in conducting
utilization review; and
``(iii) submit a report on the final determinations of the
review involved to--

``(I) the plan or issuer involved;
``(II) the enrollee involved (or the legal representative
of the enrollee); and
``(III) the health care professional involved.

``(B) Notice.--The plan or issuer involved shall ensure
that the enrollee receives notice, within 30 days after the
determination of the independent medical expert, regarding
the actions of the plan or issuer with respect to the
determination of such expert under the external review.
``(5) Timeframe for review.--
``(A) In general.--An external reviewer shall complete a
review of an adverse coverage determination in accordance
with the medical exigencies of the case.
``(B) Limitation.--Notwithstanding subparagraph (A), a
review described in such subparagraph shall be completed not
later than 30 working days after the later of--
``(i) the date on which such reviewer is designated; or
``(ii) the date on which all information necessary to
completing such review is received.
``(6) Binding determination.--The determination of an
external reviewer under this subsection shall be binding upon
the plan or issuer if the provisions of this subsection or
the procedures implemented under such provisions were
complied with by the external reviewer.
``(7) Study.--Not later than 2 years after the date of
enactment of this section, the General Accounting Office
shall conduct a study of a statistically appropriate sample
of completed external reviews. Such study shall include an
assessment of the process involved during an external review
and the basis of decisionmaking by the external reviewer. The
results of such study shall be submitted to the appropriate
committees of Congress.
``(8) Effect on certain provisions.--Nothing in this
section shall be construed as affecting or modifying section
514 of this Act with respect to a group health plan.
``(f) Rule of Construction.--Nothing in this section shall
be construed to prohibit a plan administrator or plan
fiduciary or health plan medical director from requesting an
external review by an external reviewer without first
completing the internal review process.
``(g) Definitions.--In this section:
``(1) Adverse coverage determination.--The term `adverse
coverage determination' means a coverage determination under
the plan which results in a denial of coverage or
reimbursement.
``(2) Coverage determination.--The term `coverage
determination' means with respect to items and services for
which coverage may be provided under a health plan, a
determination of whether or not such items and services are
covered or reimbursable under the coverage and terms of the
contract.
``(3) Enrollee.--The term enrollee means a participant or
beneficiary.
``(4) Grievance.--The term `grievance' means any enrollee
complaint that does not involve a coverage determination.
``(5) Group health plan.--The term `group health plan'
shall have the meaning given such term in section 733(a). In
applying this paragraph, excepted benefits described in
section 733(c) shall not be treated as benefits consisting of
medical care.
``(6) Health insurance coverage.--The term `health
insurance coverage' has the meaning given such term in
section 733(b)(1). In applying this paragraph, excepted
benefits described in section 733(c) shall not be treated as
benefits consisting of medical care.
``(7) Health insurer.--The term `health insurer' means an
insurance company, insurance service, or an insurance
organization that meets the requirements of section 733(b)(2)
and that offers health insurance coverage in connection with
a group health plan.
``(8) Prior authorization determination.--The term `prior
authorization determination' means a coverage determination
prior to the provision of the items and services as a
condition of coverage of the items and services under the
coverage.
``(9) Treating health care professional.--The term
`treating health care professional' with respect to a group
health plan, health insurance issuer or provider sponsored
organization means a practitioner who is acting within the
scope of their State licensure or certification for the
delivery of health care services and who is primarily
responsible for delivering those services to the enrollee.
``(10) Utilization review.--The term `utilization review'
with respect to a group health plan or health insurance
coverage means a set of formal techniques designed to monitor
the use of, or evaluate the clinical necessity,
appropriateness, efficacy, or efficiency of, health care
services, procedures, or settings. Techniques may include
ambulatory review, prospective review, second opinion,
certification, concurrent review, case management, discharge
planning or retrospective review.''
(b) Enforcement.--Section 502(c)(1) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132(c)(1))
is amended by inserting after ``or section 101(e)(1)'' the
following: ``, or fails to comply with a coverage
determination as required under section 503(e)(6),''.
(c) Conforming Amendment.--The table of contents in section
1 of the Employee Retirement Income Security Act of 1974 is
amended by striking the item relating to section 503 and
inserting the following new item:
``Sec. 503. Claims procedures, coverage determination, grievances and
appeals.''.
(d) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on or after
1 year after the date of enactment of this Act. The Secretary
shall issue all regulations necessary to carry out the
amendments made by this section before the effective date
thereof.
Subtitle D--Miscellaneous Provisions

SEC. 131. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

Subchapter B of chapter 100 of the Internal Revenue Code of
1986 (as amended by section 1531(a) of the Taxpayer Relief
Act of 1997) is amended--
(1) in the table of sections, by inserting after the item
relating to section 9812 the following new item:
``Sec. 9813. Standard relating to Patients' bill of rights.''; and
(2) by inserting after section 9812 the following:

``SEC. 9813. STANDARD RELATING TO PATIENTS' BILL OF RIGHTS.

``A group health plan shall comply with the requirements of
section 714 and subpart C of part 7 of subtitle B of title I
of the Employee Retirement Income Security Act of 1974 (as in
effect as of the date of the enactment of the Patients' Bill
of Rights Plus Act), and such requirements shall be deemed to
be incorporated into this section.''.
TITLE II--INDIVIDUAL RIGHTS WITH RESPECT TO PERSONAL MEDICAL
INFORMATION

SEC. 201. SHORT TITLE.

This title may be cited as the ``Personal Medical
Information Access Act''.
Subtitle A--Access to Medical Records

SEC. 211. INSPECTION AND COPYING OF PROTECTED HEALTH
INFORMATION.

(a) In General.--At the request of an individual and except
as provided in subsection (b), a health care provider, health
plan, employer, health or life insurer, school, or university
shall permit an individual who is the subject of protected
health information or the individual's designee, to inspect
and copy protected health information concerning the
individual, including records created under section 212 that
such entity maintains. Such entity may set forth appropriate
procedures to be followed for such inspection or copying and
may require an individual to pay reasonable costs associated
with such inspection or copying.
(b) Exceptions.--Unless ordered by a court of competent
jurisdiction, an entity described in subsection (a) is not
required to permit the inspection or copying of protected
health information if any of the following conditions are
met:
(1) Endangerment to life or safety.--The entity determines
that the disclosure of the information could reasonably be
expected to endanger the life or physical safety of an
individual.
(2) Confidential source.--The information identifies, or
could reasonably lead to the identification of, a person who
provided information under a promise of confidentiality
concerning the individual who is the subject of the
information.
(3) Information compiled in anticipation of litigation.--
The information is compiled principally--

[[Page S910]]

(A) in the reasonable anticipation of a civil, criminal, or
administrative action or proceeding; or
(B) for use in such an action or proceeding.
(4) Research purposes.--The information was collected for a
research project monitored by an institutional review board,
such project is not complete, and the researcher involved
reasonably believes that access to such information would
harm the conduct of the research or invalidate or undermine
the validity of the research.
(c) Denial of a Request for Inspection or Copying.--If an
entity described in subsection (a) denies a request for
inspection or copying pursuant to subsection (b), the entity
shall inform the individual in writing of--
(1) the reasons for the denial of the request for
inspection or copying;
(2) any procedures for further review of the denial; and
(3) the individual's right to file with the entity a
concise statement setting forth the request for inspection or
copying.
(d) Statement Regarding Request.--If an individual has
filed a statement under subsection (c)(3), the entity in any
subsequent disclosure of the portion of the information
requested under subsection (a) shall include--
(1) a copy of the individual's statement; and
(2) a concise statement of the reasons for denying the
request for inspection or copying.
(e) Inspection and Copying of Segregable Portion.--An
entity described in subsection (a) shall permit the
inspection and copying under subsection (a) of any reasonably
segregable portion of protected health information after
deletion of any portion that is exempt under subsection (b).
(f) Deadline.--An entity described in subsection (a) shall
comply with or deny, in accordance with subsection (c), a
request for inspection or copying of protected health
information under this section not later than 45 days after
the date on which the entity receives the request.
(g) Rules Governing Agents.--An agent of an entity
described in subsection (a) shall not be required to provide
for the inspection and copying of protected health
information, except where--
(1) the protected health information is retained by the
agent; and
(2) the agent has received in writing a request from the
entity involved to fulfill the requirements of this section;

at which time such information shall be provided to the
requesting entity. Such requesting entity shall comply with
subsection (f) with respect to any such information.
(h) Rule of Construction.--This section shall not be
construed to require an entity described in subsection (a) to
conduct a formal, informal, or other hearing or proceeding
concerning a request for inspection or copying of protected
health information.

SEC. 212. AMENDMENT OF PROTECTED HEALTH INFORMATION.

(a) Requirement.--
(1) In general.--Except as provided in subsection (b) and
subject to paragraph (2), a health care provider, health
plan, employer, health or life insurer, school, or university
that receives from an individual a request in writing to
amend protected health information shall--
(A) amend such information as requested;
(B) inform the individual of the amendment that has been
made; and
(C) make reasonable efforts to inform any person to whom
the unamended portion of the information was previously
disclosed, of any nontechnical amendment that has been made.
(2) Compliance.--An entity described in paragraph (1) shall
comply with the requirements of such paragraph within 45 days
of the date on which the request involved is received if the
entity--
(A) created the protected health information involved; and
(B) determines that such information is in fact inaccurate.
(b) Refusal To Amend.--If an entity described in subsection
(a) refuses to make the amendment requested under such
subsection, the entity shall inform the individual in writing
of--
(1) the reasons for the refusal to make the amendment;
(2) any procedures for further review of the refusal; and
(3) the individual's right to file with the entity a
concise statement setting forth the requested amendment and
the individual's reasons for disagreeing with the refusal.
(c) Statement of Disagreement.--If an individual has filed
a statement of disagreement under subsection (b)(3), the
entity involved, in any subsequent disclosure of the disputed
portion of the information--
(1) shall include a copy of the individual's statement; and
(2) may include a concise statement of the reasons for not
making the requested amendment.
(d) Rules Governing Agents.--The agent of an entity
described in subsection (a) shall not be required to make
amendments to protected health information, except where--
(1) the protected health information is retained by the
agent; and
(2) the agent has been asked by such entity to fulfill the
requirements of this section.

If the agent is required to comply with this section as
provided for in paragraph (2), such agent shall be subject to
the 45-day deadline described in subsection (a).
(e) Repeated Requests for Amendments.--If an entity
described in subsection (a) receives a request for an
amendment of information as provided for in such subsection
and a statement of disagreement has been filed pursuant to
subsection (c), the entity shall inform the individual of
such filing and shall not be required to carry out the
procedures required under this section.
(f) Rules of Construction.--This section shall not be
construed to--
(1) require that an entity described in subsection (a)
conduct a formal, informal, or other hearing or proceeding
concerning a request for an amendment to protected health
information;
(2) require a provider to amend an individual's protected
health information as to the type, duration, or quality of
treatment the individual believes he or she should have been
provided; or
(3) permit any deletions or alterations of the original
information.

SEC. 213. NOTICE OF CONFIDENTIALITY PRACTICES.

(a) Preparation of Written Notice.--A health care provider,
health plan, health oversight agency, public health
authority, employer, health or life insurer, health
researcher, school or university shall post or provide, in
writing and in a clear and conspicuous manner, notice of the
entity's confidentiality practices, that shall include--
(1) a description of an individual's rights with respect to
protected health information;
(2) the procedures established by the entity for the
exercise of the individual's rights; and
(3) the right to obtain a copy of the notice of the
confidentiality practices required under this subtitle.
(b) Model Notice.--The Secretary, in consultation with the
National Committee on Vital and Health Statistics and the
National Association of Insurance Commissioners, and after
notice and opportunity for public comment, shall develop and
disseminate model notices of confidentiality practices. Use
of the model notice shall serve as a defense against claims
of receiving inappropriate notice.
Subtitle B--Establishment of Safeguards

SEC. 221. ESTABLISHMENT OF SAFEGUARDS.

A health care provider, health plan, health oversight
agency, public health authority, employer, health or life
insurer, health researcher, law enforcement official, school
or university shall establish and maintain appropriate
administrative, technical, and physical safeguards to protect
the confidentiality, security, accuracy, and integrity of
protected health information created, received, obtained,
maintained, used, transmitted, or disposed of by such entity.
Subtitle C--Enforcement; Definitions

SEC. 231. CIVIL PENALTY.

(a) Violation.--A health care provider, health researcher,
health plan, health oversight agency, public health agency,
law enforcement agency, employer, health or life insurer,
school, or university, or the agent of any such individual or
entity, who the Secretary, in consultation with the Attorney
General, determines has substantially and materially failed
to comply with this Act shall, for a violation of this title,
be subject, in addition to any other penalties that may be
prescribed by law, to a civil penalty of not more than $500
for each such violation, but not to exceed $5,000 in the
aggregate for multiple violations.
(b) Procedures for Imposition of Penalties.--Section 1128A
of the Social Security Act, other than subsections (a) and
(b) and the second sentence of subsection (f) of that
section, shall apply to the imposition of a civil, monetary,
or exclusionary penalty under this section in the same manner
as such provisions apply with respect to the imposition of a
penalty under section 1128A of such Act.

SEC. 232. DEFINITIONS.

In this title:
(1) Agent.--The term ``agent'' means a person who
represents and acts for another under the contract or
relation of agency, or whose function is to bring about,
modify, affect, accept performance of, or terminate
contractual obligations between the principal and a third
person, including a contractor.
(2) Disclose.--The term ``disclose'' means to release,
transfer, provide access to, or otherwise divulge protected
health information to any person other than the individual
who is the subject of such information. Such term includes
the initial disclosure and any subsequent redisclosures of
protected health information.
(3) Employer.--The term ``employer'' has the meaning given
such term under section 3(5) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1002(5)), except that
such term shall include only employers of 2 or more
employees.
(4) Health care provider.--The term ``health care
provider'' means a person who, with respect to a specific
item of protected health information, receives, creates,
uses, maintains, or discloses the information while acting in
whole or in part in the capacity of--
(A) a person who is licensed, certified, registered, or
otherwise authorized by Federal or State law to provide an
item or service that constitutes health care in the ordinary
course of business, or practice of a profession;
(B) a Federal, State, or employer-sponsored program that
directly provides items

[[Page S911]]

or services that constitute health care to beneficiaries; or
(C) an officer, employee, or agent of a person described in
subparagraph (A) or (B).
(5) Health or life insurer.--The term ``health or life
insurer'' means a health insurance issuer as defined in
section 2791 of the Public Health Service Act (42 U.S.C.
300gg-91) or a life insurance company as defined in section
816 of the Internal Revenue Code of 1986.
(6) Health plan.--The term ``health plan'' means any health
insurance plan, including any hospital or medical service
plan, dental or other health service plan or health
maintenance organization plan, provider sponsored
organization, or other program providing or arranging for the
provision of health benefits, whether or not funded through
the purchase of insurance.
(7) Person.--The term ``person'' means a government,
governmental subdivision, agency or authority; corporation;
company; association; firm; partnership; society; estate;
trust; joint venture; individual; individual representative;
tribal government; and any other legal entity.
(8) Protected health information.--The term ``protected
health information'' means any information (including
demographic information) whether or not recorded in any form
or medium--
(A) that relates to the past, present or future--
(i) physical or mental health or condition of an individual
(including the condition or other attributes of individual
cells or their components);
(ii) provision of health care to an individual; or
(iii) payment for the provision of health care to an
individual;
(B) that is created by a health care provider, health plan,
health researcher, health oversight agency, public health
authority, employer, law enforcement official, health or life
insurer, school or university; and
(C) that is not nonidentifiable health information.
(9) School or university.--The term ``school or
university'' means an institution or place for instruction or
education, including an elementary school, secondary school,
or institution of higher learning, a college, or an
assemblage of colleges united under one corporate
organization or government.
(10) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(11) Writing.--The term ``writing'' means writing in either
a paper-based or computer-based form, including electronic
signatures.

SEC. 233. EFFECTIVE DATE.

The provisions of this title shall become effective
beginning on the date that is 1 year after the date of
enactment of this Act. The Secretary shall issue regulations
necessary to carry out this title before the effective date
thereof.
TITLE III--GENETIC INFORMATION AND SERVICES

SEC. 301. SHORT TITLE.

This title may be cited as the ``Genetic Information
Nondiscrimination in Health Insurance Act of 1999''.

SEC. 302. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY
ACT OF 1974.

(a) Prohibition of Health Discrimination on the Basis of
Genetic Information or Genetic Services.--
(1) No enrollment restriction for genetic services.--
Section 702(a)(1)(F) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1182(a)(1)(F)) is amended by
inserting before the period the following: ``(including
information about a request for or receipt of genetic
services)''.
(2) No discrimination in group premiums based on predictive
genetic information.--Subpart B of part 7 of subtitle B of
title I of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185 et seq.) (as amended by section 111) is
further amended by adding at the end the following:

``SEC. 714. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS
ON THE BASIS OF PREDICTIVE GENETIC INFORMATION.

``A group health plan, or a health insurance issuer
offering group health insurance coverage in connection with a
group health plan, shall not adjust premium or contribution
amounts for a group on the basis of predictive genetic
information concerning an individual in the group or a family
member of the individual (including information about a
request for or receipt of genetic services).''.
(3) Conforming amendment.--Section 702(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1182(b)) is
amended by adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or receipt of genetic services), see section
714.''.
(b) Limitation on Collection of Predictive Genetic
Information.--Section 702 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1182) is amended by adding at
the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group health
plan, shall not request or require predictive genetic
information concerning an individual or a family member of
the individual (including information about a request for or
receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a group
health plan or health insurance issuer that provides health
care items and services to an individual or dependent may
request (but may not require) that such individual or
dependent disclose, or authorize the collection or disclosure
of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health
care items and services to such individual or dependent.
``(B) Notice of confidentiality practices and description
of safeguards.--As a part of a request under subparagraph
(A), the group health plan or health insurance issuer shall
provide to the individual or dependent a description of the
procedures in place to safeguard the confidentiality, as
described in sections 213 and 221 of the Patients' Bill of
Rights Plus Act, of such individually identifiable
information.''.
(c) Definitions.--Section 733(d) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191b(d)) is amended
by adding at the end the following:
``(5) Family member.--The term `family member' means with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual, including a
child who is born to or placed for adoption with the
individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in subparagraph
(A) or (B).
``(6) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a
family member (including information about a request for or
receipt of genetic services).
``(7) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(8) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means--
``(i) information about an individual's genetic tests which
are associated with a statistically significant increased
risk of developing a disease or disorder;
``(ii) information about genetic tests of family members of
the individual; or
``(iii) information about the occurrence of a disease or
disorder in family members that predicts a statistically
significant increased risk of a disease or disorder in the
individual.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of the individual;
``(ii) information derived from routine physical tests,
such as the chemical, blood, or urine analyses of the
individual, unless such analyses are genetic tests; and
``(iii) information about physical exams of the individual
and other information relevant to determining the current
health status of the individual so long as such information
does not include information described in clauses (i), (ii),
or (iii) of subparagraph (A).
``(9) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and
certain metabolites, in order to detect disease-related
genotypes, mutations, phenotypes, or karyotypes.''.
(d) Effective Date.--Except as provided in this section,
this section and the amendments made by this section shall
apply with respect to group health plans for plan years
beginning 1 year after the date of the enactment of this Act.

SEC. 303. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

(a) Amendments Relating to the Group Market.--
(1) Prohibition of health discrimination on the basis of
genetic information in the group market.--
(A) In general.--Subpart 2 of part A of title XXVII of the
Public Health Service Act, as amended by the Omnibus
Consolidated and Emergency Supplemental Appropriations Act,
1999 (Public Law 105-277), is amended by adding at the end
the following new section:

``SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST
GROUPS ON THE BASIS OF PREDICTIVE GENETIC
INFORMATION IN THE GROUP MARKET.

``A group health plan, or a health insurance issuer
offering group health insurance coverage in connection with a
group health plan shall not adjust premium or contribution
amounts for a group on the basis of predictive genetic
information concerning an individual in the group or a family
member of the individual (including information about a
request for or receipt of genetic services).''.
(B) Conforming amendment.--Section 2702(b) of the Public
Health Service Act (42 U.S.C. 300gg-1(b)) is amended by
adding at the end the following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis

[[Page S912]]

of predictive genetic information (including information
about a request for or receipt of genetic services), see
section 2707.''.
(C) Limitation on collection and disclosure of predictive
genetic information.--Section 2702 of the Public Health
Service Act (42 U.S.C. 300gg-1) is amended by adding at the
end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group health
plan, shall not request or require predictive genetic
information concerning an individual or a family member of
the individual (including information about a request for or
receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a group
health plan or health insurance issuer that provides health
care items and services to an individual or dependent may
request (but may not require) that such individual or
dependent disclose, or authorize the collection or disclosure
of, predictive genetic information for purposes of diagnosis,
treatment, or payment relating to the provision of health
care items and services to such individual or dependent.
``(B) Notice of confidentiality practices and description
of safeguards.--As a part of a request under subparagraph
(A), the group health plan or health insurance issuer shall
provide to the individual or dependent a description of the
procedures in place to safeguard the confidentiality, as
described in sections 213 and 221 of the Patients' Bill of
Rights Plus Act, of such individually identifiable
information.''.
(2) Definitions.--Section 2791(d) of the Public Health
Service Act (42 U.S.C. 300gg-91(d)) is amended by adding at
the end the following:
``(15) Family member.--The term `family member' means, with
respect to an individual--
``(A) the spouse of the individual;
``(B) a dependent child of the individual, including a
child who is born to or placed for adoption with the
individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in subparagraph
(A) or (B).
``(16) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a
family member.
``(17) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(18) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means--
``(i) information about an individual's genetic tests which
is associated with a statistically significant increased risk
of developing a disease or disorder;
``(ii) information about genetic tests of family members of
the individual; or
``(iii) information about the occurrence of a disease or
disorder in family members that predicts a statistically
significant increased risk of a disease or disorder in the
individual.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of the individual;
``(ii) information derived from routine physical tests,
such as the chemical, blood, or urine analyses of the
individual, unless such analyses are genetic tests; and
``(iii) information about physical exams of the individual
and other information relevant to determining the current
health status of the individual so long as such information
does not include information described in clauses (i), (ii),
or (iii) of subparagraph (A).
``(19) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and
certain metabolites, in order to detect disease-related
genotypes, mutations, phenotypes, or karyotypes.''.
(b) Amendment Relating to the Individual Market.--The first
subpart 3 of part B of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-11 et seq.) (relating to other
requirements), as amended by the Omnibus Consolidated and
Emergency Supplemental Appropriations Act, 1999 (Public Law
105-277) is amended--
(1) by redesignating such subpart as subpart 2; and
(2) by adding at the end the following:

``SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE
BASIS OF PREDICTIVE GENETIC INFORMATION.

``(a) Prohibition on Predictive Genetic Information as a
Condition of Eligibility.--A health insurance issuer offering
health insurance coverage in the individual market may not
use predictive genetic information as a condition of
eligibility of an individual to enroll in individual health
insurance coverage (including information about a request for
or receipt of genetic services).
``(b) Prohibition on Predictive Genetic Information in
Setting Premium Rates.--A health insurance issuer offering
health insurance coverage in the individual market shall not
adjust premium rates for individuals on the basis of
predictive genetic information concerning such an enrollee or
a family member of the enrollee (including information about
a request for or receipt of genetic services).
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
health insurance issuer offering health insurance coverage in
the individual market shall not request or require predictive
genetic information concerning an individual or a family
member of the individual (including information about a
request for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) in general.--Notwithstanding paragraph (1), a health
insurance issuer that provides health care items and services
to an individual or dependent may request (but may not
require) that such individual or dependent disclose, or
authorize the collection or disclosure of, predictive genetic
information for purposes of diagnosis, treatment, or payment
relating to the provision of health care items and services
to such individual or dependent.
``(B) Notice of confidentiality practices and description
of safeguards.--As a part of a request under subparagraph
(A), the health insurance issuer shall provide to the
individual or dependent a description of the procedures in
place to safeguard the confidentiality, as described in
sections 213 and 221 of the Patients' Bill of Rights Plus
Act, of such individually identifiable information.''.
(c) Effective Date.--The amendments made by this section
shall apply with respect to--
(1) group health plans, and health insurance coverage
offered in connection with group health plans, for plan years
beginning after 1 year after the date of enactment of this
Act; and
(2) health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market
after 1 year after the date of enactment of this Act.

SEC. 304. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

(a) Prohibition of Health Discrimination on the Basis of
Predictive Genetic Information.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 (as amended by section 131) is
further amended by adding at the end the following:

``SEC. 9814. PROHIBITING HEALTH DISCRIMINATION AGAINST GROUPS
ON THE BASIS OF PREDICTIVE GENETIC INFORMATION.

``A group health plan shall not adjust premium or
contribution amounts for a group on the basis of predictive
genetic information concerning an individual in the group or
a family member of the individual (including information
about a request for or receipt of genetic services).''.
(2) Conforming amendment.--Section 9802(b) of the Internal
Revenue Code of 1986 is amended by adding at the end the
following:
``(3) Reference to related provision.--For a provision
prohibiting the adjustment of premium or contribution amounts
for a group under a group health plan on the basis of
predictive genetic information (including information about a
request for or the receipt of genetic services), see section
9814.''.
(3) Amendment to table of sections.--The table of sections
for subchapter B of chapter 100 of the Internal Revenue Code
of 1986 (as amended by section 131) is further amended by
adding at the end the following:

``Sec. 9814. Prohibiting premium discrimination against groups on the
basis of predictive genetic information.''.
(b) Limitation on Collection of Predictive Genetic
Information.--Section 9802 of the Internal Revenue Code of
1986 is amended by adding at the end the following:
``(c) Collection of Predictive Genetic Information.--
``(1) Limitation on requesting or requiring predictive
genetic information.--Except as provided in paragraph (2), a
group health plan shall not request or require predictive
genetic information concerning an individual or a family
member of the individual (including information about a
request for or receipt of genetic services).
``(2) Information needed for diagnosis, treatment, or
payment.--
``(A) In general.--Notwithstanding paragraph (1), a group
health plan that provides health care items and services to
an individual or dependent may request (but may not require)
that such individual or dependent disclose, or authorize the
collection or disclosure of, predictive genetic information
for purposes of diagnosis, treatment, or payment relating to
the provision of health care items and services to such
individual or dependent.
``(B) Notice of confidentiality practices; description of
safeguards.--As a part of a request under subparagraph (A),
the group health plan shall provide to the individual or
dependent a description of the procedures in place to
safeguard the confidentiality, as described in sections 213
and 221 of the Patients' Bill of Rights Plus Act, of such
individually identifiable information.''.
(c) Definitions.--Section 9832(d) of the Internal Revenue
Code of 1986 is amended by adding at the end the following:
``(6) Family member.--The term `family member' means, with
respect to an individual--

[[Page S913]]

``(A) the spouse of the individual;
``(B) a dependent child of the individual, including a
child who is born to or placed for adoption with the
individual; and
``(C) all other individuals related by blood to the
individual or the spouse or child described in subparagraph
(A) or (B).
``(7) Genetic information.--The term `genetic information'
means information about genes, gene products, or inherited
characteristics that may derive from an individual or a
family member.
``(8) Genetic services.--The term `genetic services' means
health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes,
and for genetic education and counseling.
``(9) Predictive genetic information.--
``(A) In general.--The term `predictive genetic
information' means--
``(i) information about an individual's genetic tests which
is associated with a statistically significant increased risk
of developing a disease or disorder;
``(ii) information about genetic tests of family members of
the individual; or
``(iii) information about the occurrence of a disease or
disorder in family members that predicts a statistically
significant increased risk of a disease or disorder in the
individual.
``(B) Exceptions.--The term `predictive genetic
information' shall not include--
``(i) information about the sex or age of the individual;
``(ii) information derived from routine physical tests,
such as the chemical, blood, or urine analyses of the
individual, unless such analyses are genetic tests; and
``(iii) information about physical exams of the individual
and other information relevant to determining the current
health status of the individual so long as such information
does not include information described in clauses (i), (ii),
or (iii) of subparagraph (A).
``(10) Genetic test.--The term `genetic test' means the
analysis of human DNA, RNA, chromosomes, proteins, and
certain metabolites, in order to detect disease-related
genotypes, mutations, phenotypes, or karyotypes.''.
(d) Effective Date.--Except as provided in this section,
this section and the amendments made by this section shall
apply with respect to group health plans for plan years
beginning after 1 year after the date of the enactment of
this Act.
TITLE IV--HEALTHCARE RESEARCH AND QUALITY

SEC. 401. SHORT TITLE.

This title may be cited as the ``Healthcare Research and
Quality Act of 1999''.

SEC. 402. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

Title IX of the Public Health Service Act (42 U.S.C. 299 et
seq.) is amended to read as follows:
``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

``PART A--ESTABLISHMENT AND GENERAL DUTIES

``SEC. 901. MISSION AND DUTIES.

``(a) In General.--There is established within the Public
Health Service an agency to be known as the Agency for
Healthcare Research and Quality. In carrying out this
subsection, the Secretary shall redesignate the Agency for
Health Care Policy and Research as the Agency for Healthcare
Research and Quality.
``(b) Mission.--The purpose of the Agency is to enhance the
quality, appropriateness, and effectiveness of healthcare
services, and access to such services, through the
establishment of a broad base of scientific research and
through the promotion of improvements in clinical and health
system practice, including the prevention of diseases and
other health conditions. The Agency shall promote healthcare
quality improvement by--
``(1) conducting and supporting research that develops and
presents scientific evidence regarding all aspects of
healthcare, including--
``(A) the development and assessment of methods for
enhancing patient participation in their own care and for
facilitating shared patient-physician decision-making;
``(B) the outcomes, effectiveness, and cost-effectiveness
of healthcare practices, including preventive measures and
primary, acute and long-term care;
``(C) existing and innovative technologies;
``(D) the costs and utilization of, and access to
healthcare;
``(E) the ways in which healthcare services are organized,
delivered, and financed and the interaction and impact of
these factors on the quality of patient care;
``(F) methods for measuring quality and strategies for
improving quality; and
``(G) ways in which patients, consumers, purchasers, and
practitioners acquire new information about best practices
and health benefits, the determinants and impact of their use
of this information;
``(2) synthesizing and disseminating available scientific
evidence for use by patients, consumers, practitioners,
providers, purchasers, policy makers, and educators; and
``(3) advancing private and public efforts to improve
healthcare quality.
``(c) Requirements With Respect to Rural Areas and Priority
Populations.--In carrying out subsection (b), the Director
shall undertake and support research, demonstration projects,
and evaluations with respect to--
``(1) the delivery of health services in rural areas
(including frontier areas);
``(2) health services for low-income groups, and minority
groups;
``(3) the health of children;
``(4) the elderly; and
``(5) people with special healthcare needs, including
disabilities, chronic care and end-of-life healthcare.
``(d) Appointment of Director.--There shall be at the head
of the Agency an official to be known as the Director for
Healthcare Research and Quality. The Director shall be
appointed by the Secretary. The Secretary, acting through the
Director, shall carry out the authorities and duties
established in this title.

``SEC. 902. GENERAL AUTHORITIES.

``(a) In General.--In carrying out section 901(b), the
Director shall support demonstration projects, conduct and
support research, evaluations, training, research networks,
multi-disciplinary centers, technical assistance, and the
dissemination of information, on healthcare, and on systems
for the delivery of such care, including activities with
respect to--
``(1) the quality, effectiveness, efficiency,
appropriateness and value of healthcare services;
``(2) quality measurement and improvement;
``(3) the outcomes, cost, cost-effectiveness, and use of
healthcare services and access to such services;
``(4) clinical practice, including primary care and
practice-oriented research;
``(5) healthcare technologies, facilities, and equipment;
``(6) healthcare costs, productivity, organization, and
market forces;
``(7) health promotion and disease prevention, including
clinical preventive services;
``(8) health statistics, surveys, database development, and
epidemiology; and
``(9) medical liability.
``(b) Health Services Training Grants.--
``(1) In general.--The Director may provide training grants
in the field of health services research related to
activities authorized under subsection (a), to include pre-
and post-doctoral fellowships and training programs, young
investigator awards, and other programs and activities as
appropriate. In carrying out this subsection, the Director
shall make use of funds made available under section 487.
``(2) Requirements.--In developing priorities for the
allocation of training funds under this subsection, the
Director shall take into consideration shortages in the
number of trained researchers addressing the priority
populations.
``(c) Multidisciplinary Centers.--The Director may provide
financial assistance to assist in meeting the costs of
planning and establishing new centers, and operating existing
and new centers, for multidisciplinary health services
research, demonstration projects, evaluations, training, and
policy analysis with respect to the matters referred to in
subsection (a).
``(d) Relation to Certain Authorities Regarding Social
Security.--Activities authorized in this section may include,
and shall be appropriately coordinated with experiments,
demonstration projects, and other related activities
authorized by the Social Security Act and the Social Security
Amendments of 1967. Activities under subsection (a)(2) of
this section that affect the programs under titles XVIII, XIX
and XXI of the Social Security Act shall be carried out
consistent with section 1142 of such Act.
``(e) Disclaimer.--The Agency shall not mandate national
standards of clinical practice or quality healthcare
standards. Recommendations resulting from projects funded and
published by the Agency shall include a corresponding
disclaimer.
``(f) Rule of Construction.--Nothing in this section shall
be construed to imply that the Agency's role is to mandate a
national standard or specific approach to quality measurement
and reporting. In research and quality improvement
activities, the Agency shall consider a wide range of
choices, providers, healthcare delivery systems, and
individual preferences.

``PART B--HEALTHCARE IMPROVEMENT RESEARCH

``SEC. 911. HEALTHCARE OUTCOME IMPROVEMENT RESEARCH.

``(a) Evidence Rating Systems.--In collaboration with
experts from the public and private sector, the Agency shall
identify and disseminate methods or systems used to assess
healthcare research results, particularly to rate the
strength of the scientific evidence behind healthcare
practice, recommendations in the research literature, and
technology assessments. The Agency shall make methods or
systems for evidence rating widely available. Agency
publications containing healthcare recommendations shall
indicate the level of substantiating evidence using such
methods or systems.
``(b) Healthcare Improvement Research Centers and Provider-
Based Research Networks.--
``(1) In general.--In order to address the full continuum
of care and outcomes research, to link research to practice
improvement, and to speed the dissemination of research
findings to community practice settings, the Agency shall
employ research strategies and mechanisms that will link
research directly with clinical practice in geographically
diverse locations throughout the United States, including--

[[Page S914]]

``(A) Healthcare Improvement Research Centers that combine
demonstrated multidisciplinary expertise in outcomes or
quality improvement research with linkages to relevant sites
of care;
``(B) Provider-based Research Networks, including plan,
facility, or delivery system sites of care (especially
primary care), that can evaluate and promote quality
improvement; and
``(C) other innovative mechanisms or strategies to link
research with clinical practice.
``(2) Requirements.--The Director is authorized to
establish the requirements for entities applying for grants
under this subsection.

``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE
ORGANIZATION AND DELIVERY.

``(a) Support for Efforts To Develop Information on
Quality.--
``(1) Scientific and technical support.--In its role as the
principal agency for healthcare research and quality, the
Agency may provide scientific and technical support for
private and public efforts to improve healthcare quality,
including the activities of accrediting organizations.
``(2) Role of the agency.--With respect to paragraph (1),
the role of the Agency shall include--
``(A) the identification and assessment of--
``(i) methods for the evaluation of the health of enrollees
in health plans by type of plan, provider, and provider
arrangements; and
``(ii) other populations, including those receiving long-
term care services;
``(B) the ongoing development, testing, and dissemination
of quality measures, including measures of health and
functional outcomes;
``(C) the compilation and dissemination of healthcare
quality measures developed in the private and public sector;
``(D) assistance in the development of improved healthcare
information systems;
``(E) the development of survey tools for the purpose of
measuring participant and beneficiary assessments of their
healthcare; and
``(F) identifying and disseminating information on
mechanisms for the integration of information on quality into
purchaser and consumer decision-making processes.
``(b) Centers for Education and Research on Therapeutics.--
``(1) In general.--The Secretary, acting through the
Director and in consultation with the Commissioner of Food
and Drugs, shall establish a program for the purpose of
making one or more grants for the establishment and operation
of one or more centers to carry out the activities specified
in paragraph (2).
``(2) Required activities.--The activities referred to in
this paragraph are the following:
``(A) The conduct of state-of-the-art clinical research for
the following purposes:
``(i) To increase awareness of--

``(I) new uses of drugs, biological products, and devices;
``(II) ways to improve the effective use of drugs,
biological products, and devices; and
``(III) risks of new uses and risks of combinations of
drugs and biological products.

``(ii) To provide objective clinical information to the
following individuals and entities:

``(I) Healthcare practitioners and other providers of
Healthcare goods or services.

``(II) Pharmacists, pharmacy benefit managers and
purchasers.
``(III) Health maintenance organizations and other managed
healthcare organizations.
``(IV) Healthcare insurers and governmental agencies.
``(V) Patients and consumers.

``(iii) To improve the quality of healthcare while reducing
the cost of Healthcare through--

``(I) an increase in the appropriate use of drugs,
biological products, or devices; and
``(II) the prevention of adverse effects of drugs,
biological products, and devices and the consequences of such
effects, such as unnecessary hospitalizations.

``(B) The conduct of research on the comparative
effectiveness, cost-effectiveness, and safety of drugs,
biological products, and devices.
``(C) Such other activities as the Secretary determines to
be appropriate, except that a grant may not be expended to
assist the Secretary in the review of new drugs.
``(c) Reducing Errors in Medicine.--The Director shall
conduct and support research and build private-public
partnerships to--
``(1) identify the causes of preventable healthcare errors
and patient injury in healthcare delivery;
``(2) develop, demonstrate, and evaluate strategies for
reducing errors and improving patient safety; and
``(3) promote the implementation of effective strategies
throughout the healthcare industry.

``SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

``(a) In General.--In carrying out 902(a), the Director
shall--
``(1) collect data on a nationally representative sample of
the population on the cost, use and, for fiscal year 2000 and
subsequent fiscal years, quality of healthcare, including the
types of healthcare services Americans use, their access to
healthcare services, frequency of use, how much is paid for
the services used, the source of those payments, the types
and costs of private health insurance, access, satisfaction,
and quality of care for the general population and also for
children, uninsured persons, poor and near-poor individuals,
and persons with special healthcare needs;
``(2) develop databases and tools that enable States to
track the quality, access, and use of healthcare services
provided to their residents; and
``(3) enter into agreements with public or private entities
to use, link, or acquire databases for research authorized
under this title.
``(b) Quality and Outcomes Information.--
``(1) In general.--To enhance the understanding of the
quality of care, the determinants of health outcomes and
functional status, the needs of special populations as well
as an understanding of these changes over time, their
relationship to healthcare access and use, and to monitor the
overall national impact of Federal and State policy changes
on healthcare, the Director, beginning in fiscal year 2000,
shall ensure that the survey conducted under subsection
(a)(1) will--
``(A) provide information on the quality of care and
patient outcomes for frequently occurring clinical conditions
for a nationally representative sample of the population; and
``(B) provide reliable national estimates for children and
persons with special healthcare needs through the use of
supplements or periodic expansions of the survey.
In expanding the Medical Expenditure Panel Survey, as in
existence on the date of enactment of this title) in fiscal
year 2000 to collect information on the quality of care, the
Director shall take into account any outcomes measurements
generally collected by private sector accreditation
organizations.
``(2) Annual report.--Beginning in fiscal year 2002, the
Secretary, acting through the Director, shall submit to
Congress an annual report on national trends in the quality
of healthcare provided to the American people.

``SEC. 914. INFORMATION SYSTEMS FOR HEALTHCARE IMPROVEMENT.

``In order to foster a range of innovative approaches to
the management and communication of health information, the
Agency shall support research, evaluations and initiatives to
advance--
``(1) the use of information systems for the study of
healthcare quality, including the generation of both
individual provider and plan-level comparative performance
data;
``(2) training for healthcare practitioners and researchers
in the use of information systems;
``(3) the creation of effective linkages between various
sources of health information, including the development of
information networks;
``(4) the delivery and coordination of evidence-based
healthcare services, including the use of real-time
healthcare decision-support programs;
``(5) the structure, content, definition, and coding of
health information data and medical vocabularies in
consultation with appropriate Federal and private entities;
``(6) the use of computer-based health records in
outpatient and inpatient settings as a personal health record
for individual health assessment and maintenance, and for
monitoring public health and outcomes of care within
populations; and
``(7) the protection of individually identifiable
information in health services research and healthcare
quality improvement.

``SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN
UNDERSERVED AREAS.

``(a) Preventive Services Task Force.--
``(1) Purpose.--The Agency shall provide ongoing
administrative, research, and technical support for the
operation of the Preventive Services Task Force. The Agency
shall coordinate and support the dissemination of the
Preventive Services Task Force recommendations.
``(2) Operation.--The Preventive Services Task Force shall
review the scientific evidence related to the effectiveness,
appropriateness, and cost-effectiveness of clinical
preventive services for the purpose of developing
recommendations, and updating previous recommendations,
regarding their usefulness in daily clinical practice. In
carrying out its responsibilities under paragraph (1), the
Task Force shall not be subject to the provisions of Appendix
2 of title 5, United States Code.
``(b) Primary Care Research.--
``(1) In general.--There is established within the Agency a
Center for Primary Care Research (referred to in this
subsection as the `Center') that shall serve as the principal
source of funding for primary care research in the Department
of Health and Human Services. For purposes of this paragraph,
primary care research focuses on the first contact when
illness or health concerns arise, the diagnosis, treatment or
referral to specialty care, preventive care, and the
relationship between the clinician and the patient in the
context of the family and community.
``(2) Research.--In carrying out this section, the Center
shall conduct and support research on--
``(A) the nature and characteristics of primary care
practice;
``(B) the management of commonly occurring clinical
problems;
``(C) the management of undifferentiated clinical problems;
and
``(D) the continuity and coordination of health services.
``(3) Demonstration.--The Agency shall support
demonstrations into the use of new

[[Page S915]]

information tools aimed at improving shared decision-making
between patients and their care-givers.

``SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION.

``(a) In General.--The Director shall promote innovation in
evidence-based clinical practice and healthcare technologies
by--
``(1) conducting and supporting research on the
development, diffusion, and use of healthcare technology;
``(2) developing, evaluating, and disseminating
methodologies for assessments of healthcare practices and
healthcare technologies;
``(3) conducting intramural and supporting extramural
assessments of existing and new healthcare practices and
technologies;
``(4) promoting education, training, and providing
technical assistance in the use of healthcare practice and
healthcare technology assessment methodologies and results;
and
``(5) working with the National Library of Medicine and the
public and private sector to develop an electronic
clearinghouse of currently available assessments and those in
progress.
``(b) Specification of Process.--
``(1) In general.--Not later than December 31, 2000, the
Director shall develop and publish a description of the
methods used by the Agency and its contractors for practice
and technology assessment.
``(2) Consultations.--In carrying out this subsection, the
Director shall cooperate and consult with the Assistance
Secretary for Health, the Administrator of the Health Care
Financing Administration, the Director of the National
Institutes of Health, the Commissioner of Food and Drugs, and
the heads of any other interested Federal department or
agency, professional societies, and other private and public
entities.
``(3) Methodology.--The methods employed in practice and
technology assessments under paragraph (1) shall consider--
``(A) safety, efficacy, and effectiveness;
``(B) legal, social, and ethical implications;
``(C) costs, benefits, and cost-effectiveness;
``(D) comparisons to alternative technologies and
practices; and
``(E) requirements of Food and Drug Administration approval
to avoid duplication.
``(c) Specific Assessments.--
``(1) In general.--The Director shall conduct or support
specific assessments of healthcare technologies and
practices.
``(2) Requests for assessments.--The Director is authorized
to conduct or support assessments, on a reimbursable basis,
for the Health Care Financing Administration, the Department
of Defense, the Department of Veterans Affairs, the Office of
Personnel Management, and other public or private entities.
``(3) Grants and contracts.--In addition to conducting
assessments, the Director may make grants to, or enter into
cooperative agreements or contracts with, entities described
in paragraph (4) for the purpose of conducting assessments of
experimental, emerging, existing, or potentially outmoded
healthcare technologies, and for related activities.
``(4) Eligible entities.--An entity described in this
paragraph is an entity that is determined to be appropriate
by the Director, including academic medical centers, research
institutions, professional organizations, third party payers,
other governmental agencies, and consortia of appropriate
research entities established for the purpose of conducting
technology assessments.

``SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY
IMPROVEMENT EFFORTS.

``(a) Requirement.--
``(1) In general.--To avoid duplication and ensure that
Federal resources are used efficiently and effectively, the
Secretary, acting through the Director, shall coordinate all
research, evaluations, and demonstrations related to health
services research and quality measurement and improvement
activities undertaken and supported by the Federal
Government.
``(2) Specific activities.--The Director, in collaboration
with the appropriate Federal officials representing all
concerned executive agencies and departments, shall develop
and manage a process to--
``(A) improve interagency coordination, priority setting,
and the use and sharing of research findings and data
pertaining to Federal quality improvement programs and health
services research;
``(B) strengthen the research information infrastructure,
including databases, pertaining to Federal health services
research and healthcare quality improvement initiatives;
``(C) set specific goals for participating agencies and
departments to further health services research and
healthcare quality improvement; and
``(D) strengthen the management of Federal healthcare
quality improvement programs.
``(b) Study by the Institute of Medicine.--
``(1) In general.--To provide the Department of Health and
Human Services with an independent, external review of its
quality oversight, and quality research programs, the
Secretary shall enter into a contract with the Institute of
Medicine--
``(A) to describe and evaluate current quality improvement
research and monitoring processes through--
``(i) an overview of pertinent health services research
activities and quality improvement efforts including those
currently performed by the peer review organizations and the
exploration of additional activities that could be undertaken
by the peer review organizations to improve quality;
``(ii) an analysis of the various partnership activities
that the Department of Health and Human Services has
pursued with private sector accreditation and other
quality measurement organizations;
``(iii) the exploration of programmatic areas where
partnership activities between the Federal Government and the
private sector or within the Federal Government could be
pursued to improve quality oversight of the medicare,
medicaid and child health insurance programs under titles
XVIII, XIX and XXI of the Social Security Act; and
``(iv) an identification of opportunities for enhancing
health system efficiency through simplification and reduction
in redundancy of Federal agency quality improvement efforts,
including areas in which Federal efforts unnecessarily
duplicate existing private sector efforts; and
``(B) to identify options and make recommendations to
improve the efficiency and effectiveness of such quality
improvement programs through--
``(i) the improved coordination of activities across the
medicare, medicaid and child health insurance programs under
titles XVIII, XIX and XXI of the Social Security Act and
various health services research programs;
``(ii) the strengthening of patient choice and
participation by incorporating state-of-the-art quality
monitoring tools and making information on quality available;
and
``(iii) the enhancement of the most effective programs,
consolidation as appropriate, and elimination of duplicative
activities within various federal agencies.
``(2) Requirements.--
``(A) In general.--The Secretary shall enter into a
contract with the Institute of Medicine for the preparation--
``(i) not later than 12 months after the date of enactment
of this title, of a report providing an overview of the
quality improvement programs of the Department of Health and
Human Services for the medicare, medicaid, and CHIP programs
under titles XVIII, XIX, and XXI of the Social Security Act;
and
``(ii) not later than 24 months after the date of enactment
of this title, of a final report containing recommendations.
``(B) Reports.--The Secretary shall submit the reports
described in subparagraph (A) to the Committee on Finance and
the Committee on Health, Education, Labor, and Pensions of
the Senate and the Committee on Ways and Means and the
Committee on Commerce of the House of Representatives.

``PART C--GENERAL PROVISIONS

``SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND
QUALITY.

``(a) Establishment.--There is established an advisory
council to be known as the Advisory Council for Healthcare
Research and Quality.
``(b) Duties.--
``(1) In general.--The Advisory Council shall advise the
Secretary and the Director with respect to activities
proposed or undertaken to carry out the purpose of the Agency
under section 901(b).
``(2) Certain recommendations.--Activities of the Advisory
Council under paragraph (1) shall include making
recommendations to the Director regarding--
``(A) priorities regarding healthcare research, especially
studies related to quality, outcomes, cost and the
utilization of, and access to, healthcare services;
``(B) the field of healthcare research and related
disciplines, especially issues related to training needs, and
dissemination of information pertaining to healthcare
quality; and
``(C) the appropriate role of the Agency in each of these
areas in light of private sector activity and identification
of opportunities for public-private sector partnerships.
``(c) Membership.--
``(1) In general.--The Advisory Council shall, in
accordance with this subsection, be composed of appointed
members and ex officio members. All members of the Advisory
Council shall be voting members other than the individuals
designated under paragraph (3)(B) as ex officio members.
``(2) Appointed members.--The Secretary shall appoint to
the Advisory Council 21 appropriately qualified individuals.
At least 17 members of the Advisory Council shall be
representatives of the public who are not officers or
employees of the United States. The Secretary shall ensure
that the appointed members of the Council, as a group, are
representative of professions and entities concerned with,
or affected by, activities under this title and under
section 1142 of the Social Security Act. Of such members--
``(A) 4 shall be individuals distinguished in the conduct
of research, demonstration projects, and evaluations with
respect to healthcare;
``(B) 4 shall be individuals distinguished in the practice
of medicine of which at least 1 shall be a primary care
practitioner;
``(C) 3 shall be individuals distinguished in the other
health professions;
``(D) 4 shall be individuals either representing the
private healthcare sector, including health plans, providers,
and purchasers or individuals distinguished as administrators
of healthcare delivery systems;

[[Page S916]]

``(E) 4 shall be individuals distinguished in the fields of
healthcare quality improvement, economics, information
systems, law, ethics, business, or public policy; and
``(F) 2 shall be individuals representing the interests of
patients and consumers of healthcare.
``(3) Ex officio members.--The Secretary shall designate as
ex officio members of the Advisory Council--
``(A) the Assistant Secretary for Health, the Director of
the National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, the Administrator
of the Health Care Financing Administration, the Assistant
Secretary of Defense (Health Affairs), and the Chief Medical
Officer of the Department of Veterans Affairs; and
``(B) such other Federal officials as the Secretary may
consider appropriate.
``(d) Terms.--Members of the Advisory Council appointed
under subsection (c)(2) shall serve for a term of 3 years. A
member of the Council appointed under such subsection may
continue to serve after the expiration of the term of the
members until a successor is appointed.
``(e) Vacancies.--If a member of the Advisory Council
appointed under subsection (c)(2) does not serve the full
term applicable under subsection (d), the individual
appointed to fill the resulting vacancy shall be appointed
for the remainder of the term of the predecessor of the
individual.
``(f) Chair.--The Director shall, from among the members of
the Advisory Council appointed under subsection (c)(2),
designate an individual to serve as the chair of the Advisory
Council.
``(g) Meetings.--The Advisory Council shall meet not less
than once during each discrete 4-month period and shall
otherwise meet at the call of the Director or the chair.
``(h) Compensation and Reimbursement of Expenses.--
``(1) Appointed members.--Members of the Advisory Council
appointed under subsection (c)(2) shall receive compensation
for each day (including travel time) engaged in carrying out
the duties of the Advisory Council unless declined by the
member. Such compensation may not be in an amount in excess
of the maximum rate of basic pay payable for GS-18 of the
General Schedule.
``(2) Ex officio members.--Officials designated under
subsection (c)(3) as ex officio members of the Advisory
Council may not receive compensation for service on the
Advisory Council in addition to the compensation otherwise
received for duties carried out as officers of the United
States.
``(i) Staff.--The Director shall provide to the Advisory
Council such staff, information, and other assistance as may
be necessary to carry out the duties of the Council.

``SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

``(a) Requirement of Review.--
``(1) In general.--Appropriate technical and scientific
peer review shall be conducted with respect to each
application for a grant, cooperative agreement, or contract
under this title.
``(2) Reports to director.--Each peer review group to which
an application is submitted pursuant to paragraph (1) shall
report its finding and recommendations respecting the
application to the Director in such form and in such manner
as the Director shall require.
``(b) Approval as Precondition of Awards.--The Director may
not approve an application described in subsection (a)(1)
unless the application is recommended for approval by a peer
review group established under subsection (c).
``(c) Establishment of Peer Review Groups.--
``(1) In general.--The Director shall establish such
technical and scientific peer review groups as may be
necessary to carry out this section. Such groups shall be
established without regard to the provisions of title 5,
United States Code, that govern appointments in the
competitive service, and without regard to the provisions of
chapter 51, and subchapter III of chapter 53, of such title
that relate to classification and pay rates under the General
Schedule.
``(2) Membership.--The members of any peer review group
established under this section shall be appointed from among
individuals who by virtue of their training or experience are
eminently qualified to carry out the duties of such peer
review group. Officers and employees of the United States may
not constitute more than 25 percent of the membership of any
such group. Such officers and employees may not receive
compensation for service on such groups in addition to the
compensation otherwise received for these duties carried out
as such officers and employees.
``(3) Duration.--Notwithstanding section 14(a) of the
Federal Advisory Committee Act, peer review groups
established under this section may continue in existence
until otherwise provided by law.
``(4) Qualifications.--Members of any peer-review group
shall, at a minimum, meet the following requirements:
``(A) Such members shall agree in writing to treat
information received, pursuant to their work for the group,
as confidential information, except that this subparagraph
shall not apply to public records and public information.
``(B) Such members shall agree in writing to recuse
themselves from participation in the peer-review of specific
applications which present a potential personal conflict of
interest or appearance of such conflict, including employment
in a directly affected organization, stock ownership, or any
financial or other arrangement that might introduce bias in
the process of peer-review.
``(d) Authority for Procedural Adjustments in Certain
Cases.--In the case of applications for financial assistance
whose direct costs will not exceed $100,000, the Director may
make appropriate adjustments in the procedures otherwise
established by the Director for the conduct of peer review
under this section. Such adjustments may be made for the
purpose of encouraging the entry of individuals into the
field of research, for the purpose of encouraging
clinical practice-oriented or provider-based research, and
for such other purposes as the Director may determine to
be appropriate.
``(e) Regulations.--The Director may shall issue
regulations for the conduct of peer review under this
section.

``SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT,
COLLECTION, AND DISSEMINATION OF DATA.

``(a) Standards With Respect to Utility of Data.--
``(1) In general.--To ensure the utility, accuracy, and
sufficiency of data collected by or for the Agency for the
purpose described in section 901(b), the Director shall
establish standards and methods for developing and collecting
such data, taking into consideration--
``(A) other Federal health data collection standards; and
``(B) the differences between types of healthcare plans,
delivery systems, healthcare providers, and provider
arrangements.
``(2) Relationship with other department programs.--In any
case where standards under paragraph (1) may affect the
administration of other programs carried out by the
Department of Health and Human Services, including the
programs under titles XVIII, XIX and XXI of the Social
Security Act, they shall be in the form of recommendations to
the Secretary for such program.
``(b) Statistics and Analyses.--The Director shall--
``(1) take appropriate action to ensure that statistics and
analyses developed under this title are of high quality,
timely, and duly comprehensive, and that the statistics are
specific, standardized, and adequately analyzed and indexed;
and
``(2) publish, make available, and disseminate such
statistics and analyses on as wide a basis as is practicable.
``(c) Authority Regarding Certain Requests.--Upon request
of a public or private entity, the Director may conduct or
support research or analyses otherwise authorized by this
title pursuant to arrangements under which such entity will
pay the cost of the services provided. Amounts received by
the Director under such arrangements shall be available to
the Director for obligation until expended.

``SEC. 924. DISSEMINATION OF INFORMATION.

``(a) In General.--The Director shall--
``(1) without regard to section 501 of title 44, United
States Code, promptly publish, make available, and otherwise
disseminate, in a form understandable and on as broad a basis
as practicable so as to maximize its use, the results of
research, demonstration projects, and evaluations conducted
or supported under this title;
``(2) ensure that information disseminated by the Agency is
science-based and objective and undertakes consultation as
necessary to assess the appropriateness and usefulness of the
presentation of information that is targeted to specific
audiences;
``(3) promptly make available to the public data developed
in such research, demonstration projects, and evaluations;
``(4) provide, in collaboration with the National Library
of Medicine where appropriate, indexing, abstracting,
translating, publishing, and other services leading to a more
effective and timely dissemination of information on
research, demonstration projects, and evaluations with
respect to healthcare to public and private entities and
individuals engaged in the improvement of healthcare delivery
and the general public, and undertake programs to develop new
or improved methods for making such information available;
and
``(5) as appropriate, provide technical assistance to State
and local government and health agencies and conduct liaison
activities to such agencies to foster dissemination.
``(b) Prohibition Against Restrictions.--Except as provided
in subsection (c), the Director may not restrict the
publication or dissemination of data from, or the results of,
projects conducted or supported under this title.
``(c) Limitation on Use of Certain Information.--No
information, if an establishment or person supplying the
information or described in it is identifiable, obtained in
the course of activities undertaken or supported under this
title may be used for any purpose other than the purpose for
which it was supplied unless such establishment or person has
consented (as determined under regulations of the Secretary)
to its use for such other purpose. Such information may not
be published or released in other form if the person who
supplied the information or who is described in it is
identifiable unless such person has consented (as determined
under regulations of the Secretary) to its publication or
release in other form.
``(d) Penalty.--Any person who violates subsection (c)
shall be subject to a civil monetary penalty of not more than
$10,000 for

[[Page S917]]

each such violation involved. Such penalty shall be imposed
and collected in the same manner as civil money penalties
under subsection (a) of section 1128A of the Social Security
Act are imposed and collected.

``SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND
CONTRACTS.

``(a) Financial Conflicts of Interest.--With respect to
projects for which awards of grants, cooperative agreements,
or contracts are authorized to be made under this title, the
Director shall by regulation define--
``(1) the specific circumstances that constitute financial
interests in such projects that will, or may be reasonably
expected to, create a bias in favor of obtaining results in
the projects that are consistent with such interests; and
``(2) the actions that will be taken by the Director in
response to any such interests identified by the Director.
``(b) Requirement of Application.--The Director may not,
with respect to any program under this title authorizing the
provision of grants, cooperative agreements, or contracts,
provide any such financial assistance unless an application
for the assistance is submitted to the Secretary and the
application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Director determines to be necessary to carry out the program
in involved.
``(c) Provision of Supplies and Services in Lieu of
Funds.--
``(1) In general.--Upon the request of an entity receiving
a grant, cooperative agreement, or contract under this title,
the Secretary may, subject to paragraph (2), provide
supplies, equipment, and services for the purpose of aiding
the entity in carrying out the project involved and, for such
purpose, may detail to the entity any officer or employee of
the Department of Health and Human Services.
``(2) Corresponding reduction in funds.--With respect to a
request described in paragraph (1), the Secretary shall
reduce the amount of the financial assistance involved by an
amount equal to the costs of detailing personnel and the fair
market value of any supplies, equipment, or services provided
by the Director. The Secretary shall, for the payment of
expenses incurred in complying with such request, expend the
amounts withheld.
``(d) Applicability of Certain Provisions With Respect to
Contracts.--Contracts may be entered into under this part
without regard to sections 3648 and 3709 of the Revised
Statutes (31 U.S.C. 529; 41 U.S.C. 5).

``SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

``(a) Deputy Director and Other Officers and Employees.--
``(1) Deputy director.--The Director may appoint a deputy
director for the Agency.
``(2) Other officers and employees.--The Director may
appoint and fix the compensation of such officers and
employees as may be necessary to carry out this title. Except
as otherwise provided by law, such officers and employees
shall be appointed in accordance with the civil service laws
and their compensation fixed in accordance with title 5,
United States Code.
``(b) Facilities.--The Secretary, in carrying out this
title--
``(1) may acquire, without regard to the Act of March 3,
1877 (40 U.S.C. 34), by lease or otherwise through the
Director of General Services, buildings or portions of
buildings in the District of Columbia or communities located
adjacent to the District of Columbia for use for a period not
to exceed 10 years; and
``(2) may acquire, construct, improve, repair, operate, and
maintain laboratory, research, and other necessary facilities
and equipment, and such other real or personal property
(including patents) as the Secretary deems necessary.
``(c) Provision of Financial Assistance.--The Director, in
carrying out this title, may make grants to public and
nonprofit entities and individuals, and may enter into
cooperative agreements or contracts with public and private
entities and individuals.
``(d) Utilization of Certain Personnel and Resources.--
``(1) Department of health and human services.--The
Director, in carrying out this title, may utilize personnel
and equipment, facilities, and other physical resources of
the Department of Health and Human Services, permit
appropriate (as determined by the Secretary) entities and
individuals to utilize the physical resources of such
Department, and provide technical assistance and advice.
``(2) Other agencies.--The Director, in carrying out this
title, may use, with their consent, the services, equipment,
personnel, information, and facilities of other Federal,
State, or local public agencies, or of any foreign
government, with or without reimbursement of such agencies.
``(e) Consultants.--The Secretary, in carrying out this
title, may secure, from time to time and for such periods as
the Director deems advisable but in accordance with section
3109 of title 5, United States Code, the assistance and
advice of consultants from the United States or abroad.
``(f) Experts.--
``(1) In general.--The Secretary may, in carrying out this
title, obtain the services of not more than 50 experts or
consultants who have appropriate scientific or professional
qualifications. Such experts or consultants shall be obtained
in accordance with section 3109 of title 5, United States
Code, except that the limitation in such section on the
duration of service shall not apply.
``(2) Travel expenses.--
``(A) In general.--Experts and consultants whose services
are obtained under paragraph (1) shall be paid or reimbursed
for their expenses associated with traveling to and from
their assignment location in accordance with sections 5724,
5724a(a), 5724a(c), and 5726(C) of title 5, United States
Code.
``(B) Limitation.--Expenses specified in subparagraph (A)
may not be allowed in connection with the assignment of an
expert or consultant whose services are obtained under
paragraph (1) unless and until the expert agrees in writing
to complete the entire period of assignment, or 1 year,
whichever is shorter, unless separated or reassigned for
reasons that are beyond the control of the expert or
consultant and that are acceptable to the Secretary. If the
expert or consultant violates the agreement, the money spent
by the United States for the expenses specified in
subparagraph (A) is recoverable from the expert or consultant
as a statutory obligation owed to the United States. The
Secretary may waive in whole or in part a right of recovery
under this subparagraph.
``(g) Voluntary and Uncompensated Services.--The Director,
in carrying out this title, may accept voluntary and
uncompensated services.

``SEC. 927. FUNDING.

``(a) Intent.--To ensure that the United States's
investment in biomedical research is rapidly translated into
improvements in the quality of patient care, there must be a
corresponding investment in research on the most effective
clinical and organizational strategies for use of these
findings in daily practice. The authorization levels in
subsections (b) and (c) provide for a proportionate increase
in healthcare research as the United State's investment in
biomedical research increases.
``(b) Authorization of Appropriations.--For the purpose of
carrying out this title, there are authorized to be
appropriated $185,000,000 for fiscal year 2000, and such sums
as may be necessary for each of the fiscal years 2001 through
2006.
``(c) Evaluations.--In addition to amounts available
pursuant to subsection (b) for carrying out this title, there
shall be made available for such purpose, from the amounts
made available pursuant to section 241 (relating to
evaluations), an amount equal to 40 percent of the maximum
amount authorized in such section 241 to be made available
for a fiscal year.

``SEC. 929. DEFINITIONS.

``In this title:
``(1) Advisory council.--The term `Advisory Council' means
the Advisory Council on Healthcare Research and Quality
established under section 921.
``(2) Agency.--The term `Agency' means the Agency for
Healthcare Research and Quality.
``(3) Director.--The term `Director' means the Director for
the Agency for Healthcare Research and Quality.''.

SEC. 403. REFERENCES.

Effective upon the date of enactment of this Act, any
reference in law to the ``Agency for Health Care Policy and
Research'' shall be deemed to be a reference to the ``Agency
for Healthcare Research and Quality''.

SEC. 404. STUDY.

(a) Study.--Not later than 30 days after the date of
enactment of any Act providing for a qualifying health care
benefit (as defined in subsection (b), the Secretary of
Health and Human Services, in consultation with the Agency
for Healthcare Research and Quality, the National Institutes
of Health, and the Institute of Medicine, shall conduct a
study concerning such benefit that scientifically evaluates--
(1) the safety and efficacy of the benefit, particularly
the effect of the benefit on outcomes of care;
(2) the cost, benefits and value of such benefit;
(3) the benefit in comparison to alternative approaches in
improving care; and
(4) the overall impact that such benefit will have on
health care as measured through research.
(b) Qualifying Health Care Benefit.--In this section, the
term ``qualifying health care benefit'' means a health care
benefit that--
(1) is disease- or health condition-specific;
(2) requires the provision of or coverage for health care
items or services;
(3) applies to group health plan, individual health plans,
or health insurance issuers under part 7 of subtitle B of
title I of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1181 et seq.) or under title XXVII of the
Public Health Service Act (42 U.S.C. 300gg et seq.); and
(4) was provided under an Act (or amendment) enacted on or
after January 1, 1999.
(c) Reports.--Not later than 3 years after the date of
enactment of any Act described in subsection (a), the
Secretary of Health and Human Services shall prepare and
submit to the appropriate committees of Congress a report
based on the study conducted under such subsection with
respect to the qualifying health care benefit involved.
TITLE V--ENHANCED ACCESS TO HEALTH INSURANCE COVERAGE

SEC. 501. FULL DEDUCTION OF HEALTH INSURANCE COSTS FOR SELF-
EMPLOYED INDIVIDUALS.

(a) In General.--Section 162(l)(1) of the Internal Revenue
Code of 1986 (relating to allowance of deductions) is amended
to read as follows:

[[Page S918]]

``(1) Allowance of deduction.--In the case of an individual
who is an employee within the meaning of section 401(c)(1),
there shall be allowed as a deduction under this section an
amount equal to the amount paid during the taxable year for
insurance which constitutes medical care for the taxpayer,
his spouse, and his dependents.''
(b) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
1999.

SEC. 502. FULL AVAILABILITY OF MEDICAL SAVINGS ACCOUNTS.

(a) Availability Not Limited To Accounts for Employees of
Small Employers and Self-Employed Individuals.--
(1) In general.--Section 220(c)(1)(A) of the Internal
Revenue Code of 1986 (relating to eligible individual) is
amended to read as follows:
``(A) In general.--The term `eligible individual' means,
with respect to any month, any individual if--
``(i) such individual is covered under a high deductible
health plan as of the 1st day of such month, and
``(ii) such individual is not, while covered under a high
deductible health plan, covered under any health plan--

``(I) which is not a high deductible health plan, and
``(II) which provides coverage for any benefit which is
covered under the high deductible health plan.''.

(2) Conforming amendments.--
(A) Section 220(c)(1) of such Code is amended by striking
subparagraphs (C) and (D).
(B) Section 220(c) of such Code is amended by striking
paragraph (4) (defining small employer) and by redesignating
paragraph (5) as paragraph (4).
(C) Section 220(b) of such Code is amended by striking
paragraph (4) (relating to deduction limited by compensation)
and by redesignating paragraphs (5), (6), and (7) as
paragraphs (4), (5), and (6), respectively.
(b) Removal of Limitation on Number of Taxpayers Having
Medical Savings Accounts.--
(1) In general.--Section 220 of the Internal Revenue Code
of 1986 (relating to medical savings accounts) is amended by
striking subsections (i) and (j).
(2) Medicare+choice.--Section 138 of such Code (relating to
Medicare+Choice MSA) is amended by striking subsection (f).
(c) Reduction in High Deductible Plan Minimum Annual
Deductible.--Section 220(c)(2)(A) of the Internal Revenue
Code of 1986 (relating to high deductible health plan) is
amended--
(1) by striking ``$1,500'' in clause (i) and inserting
``$1,000'', and
(2) by striking ``$3,000'' in clause (ii) and inserting
``$2,000''.
(d) Increase in Contribution Limit to 100 Percent of Annual
Deductible.--
(1) In general.--Section 220(b)(2) of the Internal Revenue
Code of 1986 (relating to monthly limitation) is amended to
read as follows:
``(2) Monthly limitation.--The monthly limitation for any
month is the amount equal to \1/12\ of the annual deductible
of the high deductible health plan of the individual.''
(2) Conforming amendment.--Section 220(d)(1)(A) of such
Code is amended by striking ``75 percent of''.
(e) Limitation on Additional Tax on Distributions Not Used
for Qualified Medical Expenses.--Section 220(f)(4) of the
Internal Revenue Code of 1986 (relating to additional tax on
distributions not used for qualified medical expenses) is
amended by adding at the end the following:
``(D) Exception in case of sufficient account balance.--
Subparagraph (A) shall not apply to any payment or
distribution in any taxable year, but only to the extent such
payment or distribution does not reduce the fair market value
of the assets of the medical savings account to an amount
less than the annual deductible for the high deductible
health plan of the account holder (determined as of January 1
of the calendar year in which the taxable year begins).''.
(f) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
1999.

SEC. 503. CARRYOVER OF UNUSED BENEFITS FROM CAFETERIA PLANS,
FLEXIBLE SPENDING ARRANGEMENTS, AND HEALTH
FLEXIBLE SPENDING ACCOUNTS.

(a) In General.--Section 125 of the Internal Revenue Code
of 1986 (relating to cafeteria plans) is amended by
redesignating subsections (h) and (i) as subsections (i) and
(j) and by inserting after subsection (g) the following new
subsection:
``(h) Allowance of Carryovers of Unused Benefits to Later
Taxable Years.--
``(1) In general.--For purposes of this title--
``(A) notwithstanding subsection (d)(2), a plan or other
arrangement shall not fail to be treated as a cafeteria plan
or flexible spending or similar arrangement, and
``(B) no amount shall be required to be included in gross
income by reason of this section or any other provision of
this chapter,

solely because under such plan or other arrangement any
nontaxable benefit which is unused as of the close of a
taxable year may be carried forward to 1 or more succeeding
taxable years.
``(2) Limitation.--Paragraph (1) shall not apply to amounts
carried from a plan to the extent such amounts exceed $500
(applied on an annual basis). For purposes of this paragraph,
all plans and arrangements maintained by an employer or any
related person shall be treated as 1 plan.
``(3) Allowance of rollover.--
``(A) In general.--In the case of any unused benefit
described in paragraph (1) which consists of amounts in a
health flexible spending account or dependent care flexible
spending account, the plan or arrangement shall provide that
a participant may elect, in lieu of such carryover, to have
such amounts distributed to the participant.
``(B) Amounts not included in income.--Any distribution
under subparagraph (A) shall not be included in gross income
to the extent that such amount is transferred in a trustee-
to-trustee transfer, or is contributed within 60 days of
the date of the distribution, to--
``(i) a qualified cash or deferred arrangement described in
section 401(k),
``(ii) a plan under which amounts are contributed by an
individual's employer for an annuity contract described in
section 403(b),
``(iii) an eligible deferred compensation plan described in
section 457, or
``(iv) a medical savings account (within the meaning of
section 220).

Any amount rolled over under this subparagraph shall be
treated as a rollover contribution for the taxable year from
which the unused amount would otherwise be carried.
``(C) Treatment of rollover.--Any amount rolled over under
subparagraph (B) shall be treated as an eligible rollover
under section 220, 401(k), 403(b), or 457, whichever is
applicable, and shall be taken into account in applying any
limitation (or participation requirement) on employer or
employee contributions under such section or any other
provision of this chapter for the taxable year of the
rollover.
``(4) Cost-of-living adjustment.--In the case of any
taxable year beginning in a calendar year after 1999, the
$500 amount under paragraph (2) shall be adjusted at the same
time and in the same manner as under section 415(d)(2),
except that the base period taken into account shall be the
calendar quarter beginning October 1, 1998, and any increase
which is not a multiple of $50 shall be rounded to the next
lowest multiple of $50.''
``(5) Applicability.--This subsection shall apply to
taxable years beginning after December 31, 1999.''
(b) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
1999.

SEC. 504. PERMITTING CONTRIBUTION TOWARDS MEDICAL SAVINGS
ACCOUNT THROUGH FEDERAL EMPLOYEES HEALTH
BENEFITS PROGRAM (FEHBP).

(a) Government Contribution to Medical Savings Account.--
(1) In general.--Section 8906 of title 5, United States
Code, is amended by adding at the end the following:
``(j)(1) In the case of an employee or annuitant who is
enrolled in a catastrophic plan described by section 8903(5),
there shall be a Government contribution under this
subsection to a medical savings account established or
maintained for the benefit of the individual. The
contribution under this subsection shall be in addition to
the Government contribution under subsection (b).
``(2) The amount of the Government contribution under this
subsection with respect to an individual is equal to the
amount by which--
``(A) the maximum contribution allowed under subsection
(b)(1) with respect to any employee or annuitant, exceeds
``(B) the amount of the Government contribution actually
made with respect to the individual under subsection (b) for
coverage under the catastrophic plan.
``(3) The Government contributions under this subsection
shall be paid into a medical savings account (designated by
the individual involved) in a manner that is specified by the
Office and consistent with the timing of contributions under
subsection (b).
``(4) Subsections (f) and (g) shall apply to contributions
under this section in the same manner as they apply to
contributions under subsection (b).
``(5) For the purpose of this subsection, the term `medical
savings account' has the meaning given such term by section
220(d) of the Internal Revenue Code of 1986.''.
(2) Allowing payment of full amount of charge for
catastrophic plan.--Section 8906(b)(2) of such title is
amended by inserting ``(or 100 percent of the subscription
charge in the case of a catastrophic plan)'' after ``75
percent of the subscription charge''.
(b) Offering of Catastrophic Plans.--
(1) In general.--Section 8903 of title 5, United States
Code, is amended by adding at the end the following:
``(5) Catastrophic plans.--One or more plans described in
paragraph (1), (2), or (3), but which provide benefits of the
types referred to by paragraph (5) of section 8904(a),
instead of the types referred to in paragraphs (1), (2), and
(3) of such section.''.
(2) Types of benefits.--Section 8904(a) of such title is
amended by inserting after paragraph (4) the following new
paragraph:
``(5) Catastrophic plans.--Benefits of the types named
under paragraph (1) or (2) of this subsection or both, to the
extent expenses covered by the plan exceed $500.''.
(3) Determining level of government contributions.--Section
8906(b) of such title is amended by adding at the end the
following: ``Subscription charges for medical savings
accounts shall be deemed to be the amount of Government
contributions made under subsection (j)(2).''.

[[Page S919]]

(c) Effective Date.--The amendments made by this section
shall apply to contract terms beginning on or after January
1, 2000.
____

Summary of Senate Republican Patients' Bill of Rights

The Senate Republican bill has six major components that
will provide consumer protections, enhance health care
quality and increase access. These are:
1. Consumer protection standards for self-funded plans.
2. Appeals standards for all group health plans.
3. Access to and confidentiality of medical information.
4. Ban on the use of genetic information for all plans.
5. New quality focus and expended research activities for
the Agency for Health Care Policy and Research.
6. Improved access to health insurance coverage by allowing
full deduction of health insurance for the self-employed and
expansion of MSAs.
The following summarizes the key aspects of the bill:
1. Consumer protection standards for self-funded plans:
Since States are responsible for regulating insured health
plans, the bill provides that the following standards would
apply only to self-funded plans governed by ERISA.
Emergency Care: Plans would be required to use the
``prudent layperson'' standard for providing initial
emergency screening exams and ``additional emergency
services'' determined necessary by a ``prudent emergency
medical professional.''
Mandatory Point of Service: Plans that offer network-only
plans would be required to offer enrollees the option to
purchase point-of-service coverage. Small employers with 50
or fewer workers would be exempt. Also exempt would be group
plans that offer a choice of two or more health insurance
options or two or more options with significantly different
providers. Plans could charge higher premiums and cost
sharing for the POS option.
OB-GYN/Pediatricians: Health plans would be required to
allow direct access to obstetricians/gynecologist and
pediatricians without referrals.
Continuity of Care: Plans who terminate or non renew
providers from their networks would be required to notify
enrollees and allow continued use of the provider (at the
same payment and cost-sharing rates) for up to 90 days if:
the enrollee is receiving institutional care, is in the
second (or late) trimester of pregnancy, or is terminally
ill.
Gag Rules: Plans would be prohibited from including ``gag
rules'' in providers' contracts.
Comparative Information: Plans would be required to provide
a wide range of information about health insurance options,
such as descriptions of the networks, premium and cost-
sharing information. Quality outcomes data and information is
not mandated.
Effective Dates: The new rules would become effective for
group plan years beginning on or after January 1 of the
second calendar year following the date of enactment. In
other words, the effective date would be January, 2001,
assuming enactment in 1999.
2. Grievance and Appeals: Plans would be required to have
written grievance procedures and have both an internal and
external appeals procedure. Grievances would not be
appealable.
Prior Authorization: Routine requests would need to be
completed within 30 days, and expedited requests for care
that could jeopardize enrollee's health would have to be
handled within 72 hours.
Qualification of Doctors for Internal Appeals: Appeals for
coverage determinations based on lack of medical necessity or
experimental treatment must be by a doctor ``with appropriate
expertise in field of medicine involved'' who was not
involved in the initial decision.
External Appeals: Enrollees and providers could appeal to
independent medical reviewers for amounts above a significant
financial threshold for issues based on medical necessity or
for services that involve an experimental treatment where the
enrollees' life is in jeopardy. External reviews could
include those licensed by the State or under Federal contract
for this purpose, a teaching hospital, or entities meeting
specific criteria. External review is binding on plans and
issuers.
3. Patient medical records: Plans, providers, schools, and
others would be required to:
Permit enrollees to inspect and copy their own medical
records, except when such information could endanger a
person's physical safety.
Disclose their confidentiality practices and to establish
appropriate safeguards for patient information.
Civil money penalties would be imposed for violations.
4. Genetic Information: All plans--self-funded and insured
group plans, as well as individual plans--would be prohibited
from denying coverage, or adjusting premiums or contribution
amounts based on ``predictive genetic information.'' The term
``predictive genetic information'' includes individual's
genetic tests, genetic tests of family members, or
information about family medical history.
5. Refocusing AHCPR on Quality Improvement: The bill would
refocus AHCPR (and rename it the Agency for Healthcare
Quality Research) to encourage overall improvement of quality
in the nation's health care systems. The new agency would
facilitate support of state-of-the-art information systems,
support of primary care research, technology assessment and
coordination of the Federal Government's own quality
improvement efforts.
6. Improved Access to Health Insurance: The bill includes
three provisions to improve access:
Allows full deduction of health insurance for self-employed
individuals.
Gives individuals the ability to carry forward up to $500
in their flexible spending accounts from one year to the next
or to be deposited into an IRA, and MSA, or a 401(k) plan.
Lifts the caps for MSAs and would allow all individuals,
including Federal employees, the option to purchase these
plans.<bullet>

<bullet> Ms. COLLINS. Mr. President, I am pleased to be joining my
colleagues in introducing this Patients' Bill of Rights, which is the
product of more than a year's worth of intensive work and negotiations
by the Senate Republican Health Care Task Force on which I serve.
This comprehensive legislation has three major purposes. First, it
will protect patients' rights and hold HMOs accountable for providing
the care they have promised. Second, it will expand consumer choice and
access to affordable care. And third, it will improve health care
quality and outcomes.
Mr. President, there is a growing unease across our country about
changes in how we receive our health care. People worry that if they or
their loved ones become seriously ill, their HMO will deny them
coverage and force them to accept either inadequate care or financial
ruin--or perhaps both.
They feel that vital decisions affecting their lives will be made,
not by a supportive family doctor, but by an unfeeling bureaucracy. The
American people, known for taking charge of their destiny, feel
increasingly powerless about their health care. Our bill will ensure
that medical decisions remain in the hands of patients and physicians,
not HMO accountants and trial lawyers.
All of us agree that medically-necessary patient care should not be
sacrificed to the bottom line. However, according to a 1997 study by
Lewin, every one percent increase in health care premiums results in as
many as 400,000 uninsured Americans. I have therefore been alarmed by
reports that American businesses everywhere--from large multinational
corporations to the corner store--are facing huge hikes in health
insurance premiums in 1999, ranging from about 8 percent on average, to
20 percent or more. This is a remarkable contrast to the last few
years, when premiums rose less than 2 or 3 percent, if at all.
We are engaged in an extremely delicate balancing act as we attempt
to respond to concerns about quality, without resorting to unduly
burdensome federal controls and mandates that will further drive up
costs, causing thousands of Americans to lose their coverage and
pushing health insurance further out of reach for many uninsured
Americans.
Our Patients' Bill of Rights does not pre-empt, but rather builds
upon the good work that states have done in the area of patients'
rights and protections. Congress agreed that states should have primary
responsibility for the regulation of health insurance when it passed
the McCarran-Ferguson Act in 1945. And, as someone who has overseen a
Bureau of Insurance in state government, I think state regulators have
done a good job of responding to the needs and concerns of their
citizens. For instance, at my last count, 44 states had passed laws
prohibiting ``gag clauses'' that restrict communications between
patients and their doctors, and the remaining six had bills pending in
their legislatures. States acted without any mandate or prod from
Washington to protect consumers.
Moreover, one size does not fit all, and what may be appropriate for
one state may not be necessary in another. Florida, for instance,
provides for direct access to a dermatologist, which is understandable,
given the high rate of skin cancer in that state. But in a state like
Maine this may not be so important.
So why does Congress need to act? The answer is that federal law
prohibits states from regulating the self-funded, employer-sponsored
health plans that cover 48 million Americans.
Our bill extends many of the same rights and protections to these
individuals and their families that Americans

[[Page S920]]

in state-regulated plans already enjoy. For the first time, they will
be guaranteed the right to talk freely and openly with their doctors
about their treatment options without being subject to ``gag clauses''
that limit communications. They will be guaranteed coverage for
emergency room care that a ``prudent layperson'' would consider
medically necessary without prior authorization from their health plan.
They will be able to see their OB-GYN or pediatrician without a
referral from their plan's ``gatekeeper,'' and they will have the
option of seeing a doctor who is not a part of their HMO's network.
They will also have some assurance of continuity of care if their
health plan terminates its contract with their doctor or hospital.
Moreover, all patients will be given the right to review their
medical records and will have added protections to ensure that this
information will be kept confidential. Finally, insurers will be
prohibited from collecting or using predictive genetic information
about a patient to deny coverage or set premium rates.
Mr. President, the states are way ahead of the federal government in
the area of insurance reform, and the State of Maine has already
enacted many of these same consumer rights and protections--a ban on
gag clauses, a prudent layperson definition for emergency care, and
direct access to OB/GYNs. Our bill would extend these and other rights
to the nearly 220,000 Maine citizens in health plans that are not
subject to state regulation and who currently do not enjoy these
protections.
A key provision of our bill would give all 125 million Americans in
employer-sponsored plans assurance that they will get the care that
they need, when they need it. This includes 535,735 people in Maine who
are in fully-insured ERISA plans. For the first time, these individuals
will be entitled to clear and complete information about their health
plan--about what it does and does not cover, about any cost-sharing
requirements, and about the plan's providers. Helping patients
understand their coverage before they need to use it will help to avoid
coverage disputes later.
The goal of any patient protection legislation should be to solve
disputes about coverage up from, when the care is needed. Not months,
or even years later, in a court room.
Our bill would accomplish this goal by creating both an internal and
external review process. First, patients or doctors who are unhappy
with an HMO's decision could appeal it internally through a review
conducted by individuals with ``appropriate expertise'' who were not
involved in the initial decision. Moreover, this review would have to
be conducted by a physician if the coverage denial is based on a
determination that the service is not medically necessary or is an
experimental treatment. Patients could expect results from this review
within 30 days, or 72 hours in cases when delay poses a serious risk to
the patient's life or health.
Patients turned down by this internal review would then have the
right to a free, external review by medical experts who are completely
independent of their health plan. This review must be completed within
thirty days--and even faster in a medical emergency or when delay would
be detrimental to the patient's health. Moreover, the decision of these
outside reviewers is binding on the health plan, but not on the
patient. If the patient is not satisfied, they retain the right to sue
in federal or state court for attorneys' fees, court costs, the value
of the benefit and injunctive relief.
Our bill differs from the Democrats' bill in a fundamental respect:
it places treatment decisions in the hands of doctors, not lawyers. If
your HMO denies you treatment that your doctor believes is medically
necessary, you should not have to resort to a costly and lengthy court
battle to get the care you need. After all, doesn't it make more sense
to put medical care in the hands of doctors, not lawyers? You should
not have a resort to hiring a lawyer and filing an expensive lawsuit to
get the treatment. You just can't sue your way to quality health care.
The purpose of our bill is to solve problems up-front when the care
is needed, not months or even years later after the harm has occurred.
According to the GAO, it takes an average of 33 months to resolve
malpractice cases. One case in the study took 11 years. This does
absolutely nothing to ensure a patient's right to timely and
appropriate care. Moreover, patients only receive 43 cents out of every
dollar awarded in malpractice cases. The rest winds up in the pockets
of the trial lawyers and administrators of the court and insurance
systems.
Finally, more lawsuits are certain to mean higher health care costs.
According to the Barents Group of KPMG Peat Marwick, increased lawsuits
could drive up premiums as much as 8.6 percent, forcing businesses to
pay $94.1 billion ($1,284 per worker) in extra premiums over five
years. Close to two million Americans could lose their health insurance
next year as increased costs force many employers to eliminate coverage
altogether, or to pass on higher premiums and out-of-pocket costs to
employees who can't afford them.
Last fall I met with a group of Maine employers who expressed their
serious concerns about the Democrats' proposal to expand liability for
health plans and employers. The Assistant Director for Human Resources
at Bowdoin College talked about how moving to a self-funded, ERISA plan
enabled them to continue to offer affordable coverage to Bowdoin
employees when premiums for their fully-insured plan skyrocketed in the
late 1980s. Since they self-funded, they have actually been able to
lower premiums for their employees, while at the same time, enhance
their benefit designs with such features as well-baby care, free annual
physicals, and prescription drug cards with low copayments. They told
me that the Democrats' proposal to expand liability seriously
jeopardizes their ability to offer affordable coverage for their
employees. Similar concerns were expressed by the Maine Municipal
Association, L.L. Bean, Bath Iron Works, and others.
Mr. President, our bill also contains important provisions to improve
health care quality and outcomes for all Americans.
For example, I am particularly pleased that our bill contains the
proposal introduced by my colleague from Maine, Senator Snowe, that
prohibits insurers from discriminating on the basis of predictive
genetic information.
Genetic testing holds tremendous promise for individuals who have a
genetic predisposition to beat cancer and other diseases and conditions
with a genetic link. However, this promise is significantly threatened
when insurance companies use the results of such testing to deny or
limit coverage to consumers on the basis of genetic information. In
addition to the potentially devastating consequences of being denied
health insurance on the basis of genetic information, the fear of
discrimination may discourage individuals who might benefit from having
this information from ever getting tested.
And finally, our bill will make health insurance more affordable by
allowing self-employed individuals to deduct the full amount of their
health care premiums beginning not in 2003, as in current law, but next
year.
Establishing parity in the tax treatment of health insurance costs
between the self-employed and those working for large businesses is a
matter of basic equity, and it will also help to reduce the number of
uninsured, but working, Americans. It will make health insurance more
affordable for the 82,000 people in Maine who are self-employed. They
include our lobstermen, our hairdressers, our electricians, our
plumbers, and the many owners of mom-and-pop stores that dot
communities throughout the state.
Mr. President, I believe that our plan strikes the right balance as
we effectively address concerns about quality and choice without
resorting to unduly burdensome federal controls and mandates that would
further drive up costs and cause some Americans to lose their health
insurance altogether. I urge all of my colleagues to join us in
cosponsoring this proposal.<bullet>
<bullet> Mr. FRIST. Mr. President, I rise to voice my support for the
bill we are introducing today and to urge my colleagues to pass a
strong Patients' Bill of Rights this year. Our Patients' Bill of Rights
is a good bill that will improve the quality of health care for
patients in this country.

[[Page S921]]

We have the benefit of starting off in a new Congress. The partisan
rhetoric of elections is behind us. Today, we are here to convey our
genuine interest to pass managed care reform this year as well as to
provide the necessary building blocks to improve health care quality.
Not much attention was given in last year's debate to the many areas
of agreement between the Republican and Democratic proposals. It is my
hope that we can work together this year in a deliberative, thoughtful
manner to pass bipartisan legislation. For example, there is bipartisan
support to enact strong patient protection standards including coverage
for emergency screening exams and services; allowing continuity of care
so that patients may keep their physician, even if he or she is dropped
from the plan, during a terminal illness, institutional care or
pregnancy; and to prohibit plans from including gag clauses in their
contracts. There is also strong consensus that we must require health
plans to provide comparative information about their plans and to hold
plans accountable for their decisions by allowing patients to appeal
coverage denials to an independent medical expert, including expedited
reviews, and receive a timely response.
In addition, I am pleased that many provisions that are in the Senate
Republican bill also have received bipartisan support. Our bill last
year included the ``Women's Health Research and Prevention
Amendments,'' which I also introduced as S. 1722, that passed the
Senate unanimously at the end of last year. These programs provide a
broad spectrum of activities to improve the quality of women's health;
including research, prevention, treatment, education and data
collection.
We must remember that the central focus of this debate--the genesis
for the entire debate--is to embark on a national discussion of how we
can truly improve real quality of care for patients. Our bill this year
will again contain two measures which have broad bipartisan support and
will greatly improve the quality of health care in this country.
Title III of our bill prohibits genetic discrimination against
individuals in health insurance. Prohibiting genetic discrimination
translates into a patient's right to quality care. Genuine quality care
means that patients and practitioners have the very best information
available to them when they make health care decisions. Patients should
not be afraid to benefit from new genetic technologies, or share
personal information that has immense potential to improve care and
save lives. This is not a political or partisan issue. Our 49
Republican cosponsors last year, several of our Democratic colleagues,
and President Clinton all support enacting legislation to prohibit
genetic discrimination.
Title IV of our bill refocuses the Agency for Health Care Policy and
Research to support our federal efforts to improve health care quality
through a vigorous research agenda. I also introduced this proposal as
a stand alone bill (S. 2208) last year which had broad bipartisan
support. Our goal is to enhance the agency to become the driving force
of our federal efforts to support the science necessary to provide
patients with information about the quality of care they receive and to
provide physicians with research data to improve health care outcomes
for their patients.
There is no question Congress will need to revisit some issues in the
managed care debate. However, we will work deliberatively and in a
bipartisan manner through our committee work this year to pass
comprehensive legislation because we all share the ultimate goal of
improving health care quality for patients.<bullet>
<bullet> Mr. JEFFORDS. Mr. President, I want to begin by commending
Senator Nickles and all of the members who participated in putting the
legislation together. I think it is solid legislation that will result
in a greatly improved health care system for Americans, and I am proud
to be a co-sponsor of the ``Patients' Bill of Rights Plus.''
As Chairman of the Committee on Health, Education, Labor, and
Pensions, with its jurisdiction of private health insurance and public
health programs, I anticipate that the Committee will have an active
health care agenda during the 106th Congress. In fact, on January 20th,
the Committee held a hearing on health plan information requirements
and internal and external appeals rights. And, this hearing builds on
the foundation of fourteen related hearings that my Committee held
during the 105th Congress.
People need to know what their plan will cover and how they will get
their health care. The ``Patients' Bill of Rights Plus'' requires full
information disclosure by an employer about the health plans he or she
offers to employees. Patients also need to know how adverse decisions
by the plan can be appealed, both internally and externally, to an
independent medical reviewer.
The limited set of standards under the Employee Retirement and Income
Security Act (ERISA) may have worked well for the simple payment of
health insurance claims under the fee-for-service system in 1974.
Today, however, our system is much more complex, and there are many
types of decisions being made--from routine reimbursements to pre-
authorizations for hospital stays. And it is in the context of these
changes, particularly the evolution of managed care, that ERISA needs
to be amended in order to give participants and beneficiaries the right
to appeal adverse coverage or medical necessity decisions to an
independent medical expert.
The provision of our bill giving consumers a new right of an external
grievance and appeals process is one of which I am particularly proud,
since it is the cornerstone of S. 1712, the Health Care QUEST Act,
which I introduced with Senator Lieberman during the last Congress.
Under the ``Patients' Bill of Rights Plus,'' enrollees will get timely
decisions about what will be covered. Furthermore, if an individual
disagrees with the plan's decision, that individual may appeal the
decision to an independent, external reviewer. The reviewer's decision
will be binding on the health plan. However, the patient maintains his
or her current rights to go to court.
As the Health and Education Committee works on health care quality
legislation, I will keep in mind three goals. First, to give families
the protections they want and need. Second, to ensure that medical
decisions are made by physicians in consultation with their patients.
And, finally, to keep the cost of this legislation low so that it
displaces no one from getting health care coverage.
Our goal is to give Americans the protections they want and need in a
package that they can afford and that we can enact. This is why I hope
the ``Patients' Bill of Rights Plus'' we have introduced today will be
enacted and signed into law by the President.<bullet>
<bullet> Mr. CRAIG. Mr. President, today, Senate Republicans are
responding to America's number one health care concern: the high cost
of health insurance and medical care. By granting all Americans access
to tax-free medical savings accounts; by allowing self-employed
Americans to deduct 100 percent of the cost of their health insurance
premiums; and by allowing workers with flexible savings accounts to
keep some of the money in those accounts, our ``Patients' Bill of
Rights--Plus'' will tear down the barriers that government has put in
the way of affordable health coverage and care.
Our proposal stands in stark contrast to those offered by others in
Congress. With millions of Americans unable to afford insurance because
of the unfairness of the federal tax code, some members of Congress
want to force consumers to buy government-prescribed benefits--
including many that are giveaways to special interests--even if it
causes millions more to lose their health coverage.
While other so-called ``patients' rights'' bills contain nothing but
expensive mandates, hidden taxes and costly lawsuits, our bill will
deliver quality health insurance to millions of Americans. Our bill
will make a down payment on serious health care reform that puts
patients first--not doctors, not lawyers, not insurance companies, and
certainly not government bureaucrats.
Rather than support a patients' bill of rights minus access, I urge
my colleagues to take a step forward by making health insurance
accessible instead of taking a step backward by making it more
expensive.<bullet>

[[Page S922]]

<bullet> Mr. BURNS. Mr. President, I am pleased to support and co-
sponsor patient protection legislation. There is noting more important
than protecting the patient-doctor relationship and guaranteeing our
citizens the right to choose their own doctor. It is important to make
sure patients have the information they need to make decisions about
their health care and make sure doctors, not accountants or lawyers,
decide which medical services are needed.
Under Senator Nickles' Patients' Bill of Rights Act, no health plan
will be beyond the scope of federal or state patient safeguards. The
bill will expand access to doctors, incuding guaranteed access to
obstetrical and gynecological care and pediatric care, and require
managed care plans to offer patients the option to receive care outside
a plan's network of doctors.
In addition, health plans would have to provide patients with
information on covered services, cost-sharing requirements, payment
restrictions for services from out-of-network providers, rules for out-
of-area coverage, preauthorization requirements and procedures, and
rules for grievence and appeals filings. Health plans would be required
to have both an internal appeal and external third-party review if
coverage for any service is denied. Plans would also be required to
safeguard patients' medical information or face civil penalties.
The Patients' Bill of Rights Act will also make it easier for many
Americans to afford health care. Over 3 million self-employed
individuals and their families will benefit from increasing the tax
deductibility of health insurance to 100 percent, the same deduction
most companies take for their employees. This bill also gives every
American the right to have medical savings accounts (MSAs) and puts
MSAs on an equal tax treatment footing with standard health care
insurance. These flexible savings plans allow you to save money for
health expenses tax-free as long as you have a high-deductible health
insurance plan. MSAs are currently only available for employees in
companies with 50 or fewer employees.
In this era of managed care, patients need a Bill of Rights to make
sure they get quality health care and not a plan that will lead to
higher costs and greater numbers of uninsured. I am happy to co-sponsor
this important legislation.<bullet>
<bullet> Mr. DOMENICI. Mr. President, I rise today in support of the
recently introduced Republican Patients' Bill of Rights.
I would like to begin by making an observation about the impact of
any potential changes to the managed care system.
I would submit that whether a decision relating to healthcare is made
by business or the government, the results will always have
consequences on the those actually utilizing the system. Let me put
that another way, we must always proceed with what the impact of any
changes will mean to families and beneficiaries.
Thus, when decisions are made, they must be thought out and done so
in a responsible manner. And I believe the Republican Patients' Bill of
Rights does just that by: holding HMO's accountable, increasing access,
improving quality and, expanding choice.
At the same time we must work to ensure that: costs are not
unnecessarily increased, more Americans are not forced into the ranks
of the uninsured and, additional layers of bureaucracy are not placed
between patients and their doctors.
Let me take just a moment to talk about the state of health care in
New Mexico.
Health care is close to a $5 billion a year industry in New Mexico.
Almost 3,000 physicians practice in the state and overall the industry
employs close to 52,000 New Mexicans. Over 600,000 New Mexicans are
enrolled in managed care plans.
With this in mind, I would like to make several points about New
Mexico as a whole, that are relevant to any debate relating to managed
care: 78% of New Mexico businesses have 10 or fewer employees and 96%
of all businesses have 50 or fewer employees. New Mexico ranks 40th in
the nation in terms of the number of people uninsured, a full 25% of
the population.
The preceding merely emphasizes a point that we must take into
consideration and that is the potential impact upon a state and its
people.
I think everyone would agree that the managed care system is not
perfect and we have all heard one or another of those so called HMO
horror stories. As a result, there is now a debate going on here and
around the country about the need for HMO/Managed Care reform.
I also want to take a moment to point out that New Mexico is already
at the forefront of HMO/Managed Care Reform.
New Mexico has already implemented many of the so called ``patient
protections'' like: no gag clauses; a prudent layperson standard for
emergency care; direct access to an OB/GYN; choice of providers; access
to prescription drugs; confidentiality of medical records and; a
grievance and appeals procedure.
I think it is important to stop and make a point that I believe is
extremely important in light of the large number of small employers and
high rate of uninsured not only in New Mexico, but the rest of the
country. For every 1% increase in premium costs, 400,000 individuals
will lose their health insurance coverage.
That is an extremely sobering thought when one realizes that small
employers often have the most difficult time providing insurance for
their employees because of the already high cost.
The Republican bill simply addresses Americans' concerns that their
rights be assured in health care coverage, in addition to increasing
access to care, improving quality of care, and expanding choice.
However, there is one thing the Bill will not do, create a new right
to go into the courts and sue managed care companies for unlimited
damages. I believe that we on this side of the aisle have adopted a
sense about health care and it says: lawyers and lawsuits do not
deliver health care. Rather, lawyers and lawsuits generally make health
care cost more.
I also think that it is very important to note that under the
Employee Retirement Income Security Act (ERISA) a participant or
beneficiary can already sue a managed care company. Let me repeat that,
the right to sue a HMO is already available.
Now why would we want to create even more lawsuits, when for years we
have been attempting to enact tort reform.
I know many New Mexicans share in the fears expressed by many
Americans about the availability and quality of their health care. That
is why I support the Republican Patients' Bill of Rights because it
will ensure that patients receive: more affordable care and more
choices; greater access to more and better information about health
plans, benefits and the doctors that provide their care; and the
advantages of a system that holds health plans accountable for medical
decisions through a strong internal and external appeals process.
The Bill reforms the Agency for Health Care Policy and Research,
renaming it the Agency for Healthcare Quality Research (AHQR). It will
make annual reports on the state of quality and cost of America's
health care, support primary care research in underserved rural and
urban areas, provide technology assessment, and coordinate federal
quality improvement efforts.
Furthermore, the Bill includes a provision that will prohibit
insurance plans from using predictive genetic information to deny
coverage or to set premium rates.
Finally, the Bill would provide relief to those New Mexicans and
Americans who are self-employed by allowing them to deduct 100% of
their health insurance costs. More than 25 million people live in
families headed by a self-employed individual (5.1 million of whom are
currently uninsured).
In closing, I believe that the key to improving our healthcare system
and to improving our HMO/Managed Care System is to work together.
As I have said, we must find a solution that would most benefit not
only New Mexicans, but everyone across our country. However, at the
same time we must remember that our decisions cannot affect these same
people in an adverse manner.<bullet>
______

By Mr. CAMPBELL:

[[Page S923]]

S. 301. A bill to amend title 39, United States Code, relating to
mailability, false representations, civil penalties, and for other
purposes; to the Committee on Governmental Affairs.

HONESTY IN SWEEPSTAKES ACT OF 1999

<bullet> Mr. CAMPBELL. Mr. President, today I introduce the Honesty in
Sweepstakes Act of 1999. This bill addresses one of the most troubling
and persistent consumer abuse issues we face today: highly deceptive,
and all too often financially damaging, sweepstakes and other mass mail
promotions.
Our nation's seniors and other vulnerable consumers are clearly being
taken advantage of, and in some cases seriously financially harmed, by
intentionally misleading sweepstakes promotions. Thousands of
nationwide victims are being deliberately misled into believing that
they have just won or are likely to win a sweepstakes when in fact they
have neither won nor are in fact likely to win such a prize.
Each year American consumers also receive hundreds of millions of
cashier's check look-alikes that deceptively masquerade as real
cashier's checks while actually being worthless. These ploys unfairly
prey upon some people's hopes and dreams.
Over the years sweepstakes have become increasingly sophisticated and
deceptive. While these promotional tactics may be technically legal
they are designed to skirt the intentions and outer limits of the law.
These deceptive tactics run counter to core American values of honesty
and forthrightness. There is abundant evidence, including the deceptive
sweepstakes and other promotions each of us receives in our mailboxes
on a regular basis, that current laws aimed at stopping these deceptive
promotions simply are not working. Something needs to be done.
This bill addresses these deceptive sweepstakes and cashier's checks
look-alikes by requiring up-front, clear and easy to read Honesty in
Sweepstakes disclosures that will help protect consumers by
counterbalancing false promises and deception. While honest and
straight-forward sweepstakes promoters have nothing to fear from this
bill, those promotions that revert to false and deceptive tactics will
feel the heat.
The Honesty in Sweepstakes Act of 1999 is a refined version of my
original legislation, S. 2141, that I introduced during the 105th
Congress. The bill I am introducing today incorporates valuable input I
received during a Senate hearing on S.2141 and from productive
discussions and negotiations involving key interested parties. Included
among those who have made valuable contributions are: my Senate
colleagues; the U.S. Postal Service; the General Accounting Office;
Attorneys General from several states including Colorado, Florida,
Michigan and New York; the American Association of Retired Persons; the
Consumer Federation of America; the National Consumers League; the
Direct Marketing Association; the Magazine Publishers of America and
other industry representatives and experts. I want to thank them for
their contributions to the Honesty in Sweepstakes Act of 1999.
The AARP has informed me that ``Research has shown that older
Americans may be particularly vulnerable to techniques used by
sweepstakes companies. At times they end up purchasing products that
they do not want in the hopes of improving their chances of winning.
Additionally, it has been shown that participation in these sweepstakes
can lead to a rise in the number of telemarketing calls a person
receives as well as an increase in mailed solicitations.''
The Honesty in Sweepstakes Act of 1999 will go a long way toward
protecting our nation's seniors and other vulnerable consumers from
misleading and deceptive sweepstakes promotions. The most vulnerable
consumers among us deserve this protection. I urge my colleagues to
support this legislation.
I ask unanimous consent that this bill and a letter from the AARP be
printed in the Record.
There being no objection, the items were ordered to be printed in the
Record, as follows:

S. 301

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. HONESTY IN SWEEPSTAKES ACT OF 1999.

(a) Short Title.--This Act may be cited as the ``Honesty in
Sweepstakes Act of 1999''.
(b) Unmailable Matter.--Section 3001 of title 39, United
States Code, is amended by--
(1) redesignating subsections (j) and (k) as subsections
(l) and (m), respectively; and
(2) inserting after subsection (i) the following:
``(j)(1) Matter otherwise legally acceptable in the mails
that--
``(A) constitutes a solicitation or offer in connection
with the sales promotion for a product or service (including
any sweepstakes) that includes the chance or opportunity to
win anything of value; and
``(B) contains words or symbols that suggest that--
``(i) the recipient has or will receive anything of value
if that recipient has in fact not won that thing of value; or
``(ii) the recipient is likely to receive anything of value
if statistically the recipient is not likely to receive
anything of value,

shall not be carried or delivered by mail, and may be
disposed of as the Postal Service directs, unless such matter
bears the notice described in paragraph (2).
``(2)(A) The notice referred to in paragraph (1) is the
following notice:
``(i) `This is a game of chance (or sweepstakes, if
applicable). You have not automatically won. Your chances of
winning are (inserting corresponding mathematical probability
for each prize shown). No purchase is required either to win
a prize or enhance your chances of winning a prize.', or a
notice to the same effect in words which the Postal Service
may prescribe; or
``(ii) a standardized Postal Service designed warning label
to the same effect as the Postal Service may prescribe.
``(B) The notice described in subparagraph (A) shall be in
conspicuous and legible type in contrast by typography,
layout, or color with other printing on its face, in
accordance with regulations that the Postal Service shall
prescribe and be prominently displayed on the first page of
the enclosed printed material and on any other pages
enclosed.
``(C) If the matter described in paragraph (1) is an
envelope, the face of the envelope shall bear the notice
described in subparagraph (A).
``(D) If the matter described in paragraph (1) is an order
entry device, the face of the order entry device shall bear
the following notice:
`` `This is a game of chance (or sweepstakes, if
applicable). No purchase is required either to win a prize or
enhance your chances of winning a prize.', or a notice to the
same effect in words which the Postal Service may prescribe.
``(k) Matter otherwise legally acceptable in the mails that
constitutes a solicitation or offer in connection with the
sales promotion for a product or service that uses any matter
resembling a negotiable instrument shall not be carried or
delivered by mail, and may be disposed of as the Postal
Service directs, unless such matter bears on the face of the
negotiable instrument in conspicuous and legible type in
contrast by typography, layout, or color with other printing
on its face, in accordance with regulations which the Postal
Service shall prescribe the following notice: `This is not a
check (or negotiable instrument). This has no cash value.',
or a notice to the same effect in words which the Postal
Service may prescribe.''.
(c) Technical Amendment.--Section 3005(a) of title 39,
United States Code, is amended by--
(1) striking ``or'' after ``(h),'' both places it appears;
and
(2) inserting ``, (j), or (k)'' after ``(i)''.
(d) Penalties.--
(1) In general.--Section 3012 of title 39, United States
Code, is amended--
(A) by redesignating subsections (b), (c), and (d), as
subsections (c), (d), and (e), respectively;
(B) by inserting after subsection (a) the following:
``(b) Any person who, through use of the mail, sends any
matter which is nonmailable under sections 3001 (a) through
(k), 3014, or 3015 of this title, shall be liable to the
United States for a civil penalty in accordance with
regulations the Postal Service shall prescribe. The civil
penalty shall not exceed $50,000 for each mailing of less
than 50,000 pieces; $100,000 for each mailing of 50,000 to
100,000 pieces; with an additional $10,000 for each
additional 10,000 pieces above 100,000, not to exceed
$2,000,000.'';
(C) in subsection (c)(1) and (2), as redesignated, by
inserting after ``of subsection (a)'' the following: ``or
subsection (b),''; and
(D) in subsection (d), as redesignated, by striking
``Treasury of the United States'' and inserting ``Postal
Service Fund established by section 2003 of this title''.
(2) Allocation of Funds.--It is the sense of Congress that
civil penalties collected through the enforcement of the
amendment made by paragraph (1) should be allocated by the
Postal Service to increase consumer awareness of misleading
solicitations received through the mail, including releasing
an annual listing of the top 10 offenders of the Honesty in
Sweepstakes Act of 1999.
(e) No Preemption.--Nothing in this Act shall preempt any
State law that regulates advertising or sales promotions or
goods and services that includes the chance or opportunity to
win anything of value.

[[Page S924]]

____
AARP,

Washington, DC, January 22, 1999.
Hon. Ben Nighthorse Campbell,
Russell Senate Office Building, Washington, DC.
Dear Senator Campbell: AARP thanks you for drawing
attention to the problem of deceptive and misleading
sweepstakes solicitations by introducing the ``Honesty in
Sweepstakes Act of 1999.'' Research has shown that older
Americans may be particularly vulnerable to techniques used
by sweepstakes companies. At times they end up purchasing
products that they do not want in the hopes of improving
their chances of winning. Additionally, it has been shown
that participation in these sweepstakes can lead to a rise in
the number of telemarketing calls a person receives as well
as an increase in mailed solicitations.
AARP appreciates your efforts on behalf of consumers to
eradicate the practice of fraudulent sweepstakes mailings
through the introduction of the ``Honesty in Sweepstakes Act
of 1999.'' We look forward to working with you and other
Members on a bi-partisan basis to address this issue in the
106th Congress.
Sincerely,
Horace B. Deets.<bullet>

____________________